NCLEX

Brachytherapy interventions

- Internal radiation (brachytherapy) involves direct application of a radioactive implant to the cancerous site or tumor for a short time, usually 24-72 hours. - Time spent near the radiation source is restricted. The guideline is to limit staff time spent in the room to 30 minutes per shift. Cluster nursing care to minimize exposure to the radiation source Rotate daily staff responsibilities to limit time spent in the client room All staff must wear a dosimeter film badge when assigned to care for a client receiving internal radiation No individuals who are pregnant or under age 18 may be in the room - All staff and visitors must keep the maximum distance possible from the radiation source. Maintaining a distance of at least 6 feet is an established standard. Assign the client to a private room with a private bath Keep the door to the room closed Ensure that a sign stating, "Caution, Radioactive Material" is affixed to the door Instruct the client to remain on bedrest to prevent dislodgement of the implant - Shielding with lead diminishes exposure to radiation. All staff providing nursing care that requires physical contact must wear a lead apron.

osteomalacia interventions?

- Is a disease that weakens bones and can cause them to break more easily. It is a disorder of decreased mineralization, which results in bone breaking down faster than it can re-form. It is a condition that occurs in adults. In children, inadequate concentrations of vitamin D may cause rickets. - Safety Light to moderate activity Supplementation Calcium, Phosphorus, Vitamin D

Codeine For? Precautions?

- Is a narcotic analgesic used for acute pain or as a cough suppressant - Depressing the cough reflex can cause an accumulation of secretions in the presence of chronic obstructive pulmonary disease (COPD), leading to respiratory difficulty.

Acanthosis nigricans

- Is a skin condition that occurs with obesity and diabetes and appears as velvet-like patches of darkened, thick skin - axilla, neck - Skin tags (acrochordons) are commonly present on regions affected by acanthosis nigricans. - Both indicate insulin resistance (diabetic dermopathy). Report to HCP

Arteriovenous malformation (AVM) Where is it usually found? What can it cause? High risk for? Interventions?

- Is a tangle of veins and arteries - Do not have a capillary bed, causing them to become weak and dilated - Usually found in the brain and can cause seizures, headaches, and neurologic deficits - Blood pressure control is crucial - High risk for having an intracranial bleed as the veins can easily rupture (Any neurologic changes, sudden severe headache, nausea, and vomiting should be evaluated immediately)

Phenytoin (Dilantin) for? Precautions?

- Is an antiseizure medication with a therapeutic index of 10-20 mcg/mL (40-79 mcmol/L) - Tube feedings decrease phenytoin absorption - Pause tube feedings for 1-2 hours before and after phenytoin administration - Gingival hyperplasia (ie, swollen, bleeding gums) is common - Horizontal nystagmus(eyes make repetitive, uncontrolled movements) and gait unsteadiness - early toxicity - may cause seizure

Baclofen For?

- Is an antispasmodic drug commonly prescribed to clients with multiple sclerosis to relieve uncomfortable spasms and muscular pain - Multiple Sclerosis - muscle weakness, spasticity, incoordination, loss of balance, and fatigue are usually present, causing impaired mobility and risk for fall and injury; Ataxia and diplopia are expected s/s - Dizziness when attempting to stand or changing positions (ie, orthostatic hypotension) is a common adverse effect but is not a contraindication.

Pavlik harness Care

- It maintains the infant's hips in a slightly flexed and abducted position (ie, legs bent and spread apart), allowing for proper hip development - worn for 3-5 months or until the hip joint is stable. - Assess skin 2-3 times daily - Dress the child in a shirt and knee socks under the harness to protect the skin - Apply diapers underneath the straps to keep the harness clean and dry - Leave the harness on at all times, unless otherwise indicated by the HCP

What is expected of a preterm baby

- Lanugo - a fine, downy hair found mostly on the backs and shoulders of preterm newborns, begins disappearing around 36 weeks gestation - Newborn also has smooth, pink skin with visible veins as skin is thin and transparent with lack of subcutaneous fat

Preterm baby characteristics we can find on them?

- Lanugo - fine, downy hair found mostly on the backs and shoulders - Smooth, pink skin with visible veins - Areolae barely visible

Malignant hyperthermia due to? s/s treatment?

- Life-threatening inherited muscle abnormality that is triggered by certain drugs used to induce general anesthesia, including inhaled anesthetics (eg, desflurane, isoflurane, halothane) and succinylcholine(a paralytic used adjunctively for intubation and general anesthesia) -s/s- Hypercapnia (earliest sign), generalized muscle rigidity (eg, jaw, trunk, extremities), and hyperthermia(Late sign) -Notify the health care provider, indicating the need for immediate treatment (eg, dantrolene, cooling blanket, fluid resuscitation)

Homonymous hemianopsia following an acute stroke - intervention?

- Loss in half of the visual field on the same side - They are taught to turn the head and scan to the side with the visual field deficit - Reduce the risk for injury and self-neglect.

Right-sided mastectomy with lymph node removal what may occur? interventions

- Lymphedema may occur Interventions -Decongestive therapy (massage technique to mobilize fluid) -Compression sleeves or intermittent pneumatic compression sleeve -Elevation of arm above the heart -Isometric exercises -Avoidance of venipunctures (eg, IV catheter insertion, blood draw), blood pressure measurements, and injections (eg, vaccinations) on the affected limb - Injury prevention (limb less sensitive to temperature changes) Infection prevention (limb more prone to infection through skin breaks)

Abdominal aortic aneurysm

- Manifest as - acute-onset abdominal pain radiating to the back - A pulsatile mass in the periumbilical area

Suctioning tracheostomy steps?

- Max 10 sec - Wait 1-2 min in between - Inserted while not suctioning - Medium pressure

Electroencephalogram (EEG) preparation? expect what?

- May result in seizure - Wash hair Avoid stimulants and depressants Can eat except coffee and cocoa(has caffeine)

Foods rich in iron

- Meats (eg, beef, lamb, liver, chicken, pork) Shellfish (eg, oysters, clams, shrimp) Eggs, green leafy vegetables, broccoli, dried fruits, dried beans, brown rice, and oatmeal - Eating foods rich in vitamin C (eg, citrus fruits, potatoes, tomatoes, green vegetables) with iron-rich foods will enhance iron absorption -

Transdermal fentanyl patch

- Moderate to severe chronic pain - not for acute - Continuous analgesia for up to 72 hours.

Sjögren's syndrome What is it? What does it affect? Treatment?

- Moisture-producing exocrine glands of the body are attacked by white blood cells - Causes- Dry eyes (xerophthalmia) and dry mouth (xerostomia) - Can lead to corneal ulcerations, dental caries, and oral thrush. Skin - dry skin and rashes Throat and bronchi - chronic dry cough Vagina - vaginal dryness and painful intercourse - treatment - preservative-free artificial tears artificial saliva

Ketorolac Precautions

- NSAID - Usage not exceed 5 days - lots of side effects - Z track method

Addisonian crisis s/s? intervention?

- Nausea, vomiting, and abdominal pain - Hypotension, tachycardia, dehydration, hyperkalemia, hyponatremia, hypoglycemia, fever, weakness, and confusion -Intervention- Shock management, with fluid resuscitation using 0.9% normal saline and 5% dextrose; and administration of high-dose hydrocortisone replacement IV push.

Opioid withdrawal

- Nausea, vomiting, diarrhea, cramping, increased bowel sounds - increased pulse/BP/ diaphoresis - Insomnia, yawning, dysphoric mood Management - Methadone (preferred) or Buprenorphine

Neonatal Abstinence Syndrome (NAS) what is it? What will happen once it is born?

- Neonate born to an opioid-dependent mother - Withdrawal within 24-48 hours - Swaddle and keep a quiet environment - Manifestation: - Autonomic nervous system symptoms - stuffy nose, sweating, frequent yawning and sneezing, tachycardia, and tachypnea - Central nervous system symptoms - irritability, restlessness, high-pitched crying, abnormal sleep pattern, and hypertonicity/hyperactive primitive reflexes. - Gastrointestinal symptoms - poor feeding, vomiting, and diarrhea

BNP level?

- Normal <100 pg/mL - Used to differentiate dyspnea of heart failure from dyspnea of noncardiac etiology - High in acute decompensated heart failure

Respiratory acidosis

- Normal PaCo2 is 35 to 45 mm Hg. - In respiratory acidosis, the pH is low and PaCo2 is elevated.

Hypocalcemia test

- Normal serum calcium is 8.6-10.2 mg /dL - Trousseau's sign may indicate hypocalcemia before other signs and symptoms of hypocalcemia, such as tetany, occur. Trousseau's sign can be elicited by placing the BP cuff on the arm, inflating to a pressure > than systolic BP, and holding in place for 3 minutes. This will occlude the brachial artery and induce a spasm of the muscles of the hand and forearm when hypocalcemia is present. - Chevostek's sign another early indicator of hypocalcemia, should also be assessed. It may be elicited by tapping the face at the angle of the jaw and observing for contraction on the same side of the face.

Rib fractures

- Normal to have shallow breathing and pain on inspiration - Pain management and pulmonary hygiene ; don't report to HCP

Client with schizo having delusions interventions?

- Not arguing or challenging the belief - Reinforcing reality by talking about and encouraging the client to participate in real events. The nurse should not delve into or have long conversations about the delusional belief system

Proton Pump Inhibitors Side effects?

- Omeprazole, pantoprazole, esomeprazole - Decrease the absorption of calcium and promote osteoporosis - Increased risk of diarrhea caused by Clostridium difficile - Increased risk of pneumonias

Autism spectrum disorder (ASD) - s/s - assessment of what?

- Onset of abnormal functioning before age 3 - 2 core symptoms of ASD are abnormalities in social interactions and communication (verbal and nonverbal), and patterns of behavior, interests, or activities that can be restricted and repetitive - Social skills, especially communication, are delayed more significantly than other developmental functioning and are the focus during client assessment. - Limit physical contact until conferring with the child's caregiver to assess which actions are soothing and which may trigger behavioral outbursts

Joint dislocation at risk for?

- Orthopedic emergency -Can compress surrounding vasculature, causing limb-threatening distal ischemia

Seizure precautions steps

- Oxygen and suction apparatus -Side rails up and padded -Pillow to protect head -Side-lying position -Bed lowest position -Loosened clothing -Never put anything in mouth

ubilical cord

- Oxygenated blood is transported to the fetus by one umbilical vein - Arteries carry deoxygenated blood and waste products from the fetus, and the umbilical vein carries oxygenated blood and provides oxygen and nutrients to the fetus

Myocardial infarction - can be caused by? - med?

- PVC's after an MI is dangerous - Can be caused by electrolyte imbalance - Potassium, magnesium, and apical-radial pulse - Administer Amiodarone - Report to HCP - Acute myocardial infarction ST-segment elevation is seen in only localized lead Acute pericarditis - all leads

Renal colic

- Pain caused by a kidney stone - Flank pain radiating to the groin

Peripheral artery disease s/s alleviate symptoms how? Interventions?

- Pain due to decreased blood flow is the most common symptom of PAD. - Cramping pain in the muscles of the legs during exercise, known as intermittent claudication, is usually relieved with rest - "burning pain" that is worsened by elevating the legs and improved when the legs are dependent - Ulcers and gangrene occur usually at the most distal part of the body -A progressive walking program will aid the development of collateral circulation.

Positioning Abdominal paracentesis Air embolus Chest tube placement

- Paracentesis - high Fowler - In the event of an air embolus, the head of the bed should be lowered (Trendelenburg) and the client positioned on the left side - Chest tube insertion should be performed with the client's arm raised above the head on the affected side. If possible, the head of the bed should be raised 30-60 degrees to reduce risk of injury to the diaphragm -

Hiatal hernia what type of hernia is a medical emergency

- Paraesophageal hernias are a medical emergency -

supraventricular tachycardia interventions?

- Paroxysmal supraventricular tachycardia (PSVT) is episodes of rapid heart rate that start in a part of the heart above the ventricles. "Paroxysmal" means from time to time. -Treatment includes vagal stimulation and drug therapy. - Common vagal maneuvers include Valsalva, coughing, and carotid massage. - IV adenosine(bolus IV over 1-2 seconds followed by a 20-mL saline flush. Repeat boluses of 12 mg may be given twice if the rapid rhythm persists. The injection site should be as close to the heart as possible (eg, antecubital area)) is the drug of choice to convert SVT to a sinus rhythm - if med con't work, synchronized cardioversion is used (supraventricular tachy with pulse only) )

Physical restraint

- Performing hourly neurovascular check - Briefly releasing restraints for skin integrity assessment and range of motion exercises every 2 hours - Trial discontinuations are not permitted. - The nurse should regularly reassess (eg, every hour) the client's continued need for restraints.

Intrauterine devices s/s of complications

- Period abnormalities (eg. late, missed, irregular,lighter, or heavier menses - Abdominal pain, pain during sexual intercourse - Infection (ie. potential exposure to STIs - Not feeling well (eg. fever, chills) - Strings longer, shorter, or missing - Check string position weekly in first 4 weeks and after each menses

Bell Palsy s/s Intervention

- Peripheral, unilateral facial paralysis characterized by inflammation of the facial nerve (cranial nerve VII) in the absence of a stroke or other causative agent/disease - Inability to completely close the eye on the affected side - Alteration in tear production (eg, decreased tearing with extreme dryness, excessive tearing) due to weakness of the lower eyelid muscle - Flattening of the nasolabial fold on the side of the paralysis - Inability to smile or frown symmetrically - Eye care: Use glasses during the day; wear a patch (or tape the eyelids) at night to protect the exposed eye. Use artificial tears during the day as needed to prevent excess drying of the cornea - Oral care: Chew on the unaffected side to prevent food trapping; a soft diet is recommended. Maintain good oral hygiene after every meal to prevent problems from accumulated residual food (eg, parotitis, dental caries)

Cervical cerclage Used for? Discharge teaching?

- Placed to prevent preterm delivery, usually in clients with histories of second trimester loss or premature birth - Discharge instructions include activity restriction and recognition of signs of preterm labor (eg, low back aches, contractions, pelvic pressure) and rupture of membranes

Placenta previa risk for? interventions? s/s? contraindications?

- Placenta implanted over or very near the cervix(exit) - Risk for hemorrhage - Interventions (Ultrasound at 36 weeks because placenta may potentially migrate) - Painless vaginal bleeding after 20 weeks gestation - Pelvic rest - no intercourse, nothing per vagina - Digital vaginal examinations are contraindicated in the presence of vaginal bleeding of unknown origin. - The client has a soft, relaxed, nontender uterus, and fundal height may be more than expected for gestational age.

Hemorrhoidectomy intervention?

- Postoperative - pain management and constipation prevention

Tonsillectomy

- Postoperative hemorrhage from tonsillectomy is uncommon but may occur up to 14 days after surgery. - The nurse should instruct this parent that the child should not resume strenuous activity or contact sports for at least 7-14 days post surgery.

Barium Enema Preprocedure? Postprocedure?

- Preprocedure Take a cathartic to empty stool Clear liquid diet, avoid red and purple liquids Do not eat or drink anything 8 hours before test Feeling of abdominal cramping and urge to defecate - Postprocedure Passage of chalky, white stool Take laxative to expel barium Drink plenty of fluids

Types of play?

- Preschoolers(age 3-6) enjoy associative play (Engage in similar activities or play with the same or similar items, but the play is unorganized without specific goals or rules.) - School-age children (age 6-12) Cooperative play is common (Specific goal and rules) - Parallel play is more common in toddlers (age 1-3) - Solitary play is common in infants (birth to 1 year)

Colchicine For?

- Prescribed for clients with an acute attack of gout

Magnesium S/S of deficiency and toxicity? Antidote?

(1.5-2.5 mEq/L) Hypomagnesium - causes Torsades de pointes - is a type of polymorphic ventricular tachycardia coupled with a prolonged QT interval; it is a lethal cardiac arrhythmia that leads to decreased cardiac output and can develop quickly into ventricular fibrillation - neuromuscular excitability, include tremors, hyperactive reflexes, positive Trousseau and Chvostek signs, and seizure Hypermagnesium - Absent deep tendon reflexes, respiratory depression, cardiac arrest - Calcium gluconate - antidote

Head circumference:

(33-35cm)

Triglycerides

(<150)

Total cholesterol

(<200)

Amyotrophic lateral sclerosis

(ALS) - progressive loss of motor neurons in the brainstem and spinal cord. - Clients have spasticity, muscle weakness, and atrophy. Neurons involved in swallowing and respiratory function are eventually impaired, leading to aspiration, respiratory failure, and death. - Dysarthia - worsening ability to speak - affects respiratory muscles

Otorrhea

(cerebrospinal fluid leaking from the ear)

Glycoprotein (GP) IIb/IIIa receptor inhibitors

(eg, abciximab, eptifibatide, tirofiban) - platelet inhibitors to prevent the occlusion of treated coronary arteries during percutaneous coronary intervention procedures and prevent acute ischemic complications. - Some clients may develop serious thrombocytopenia within a few hours, further increasing the bleeding risk

Macrolide antibiotics

(eg, azithromycin, erythromycin, clarithromycin) - Can cause a prolonged QT interval, which may lead to sudden cardiac death due to torsades de pointes

Latex allergy

(eg, banana, tomato, avocado), spina bifida - NOT shellfish, that's iodine

Potassium-sparing diuretics

(eg, spironolactone, triamterene, eplerenone)

Teletherapy intervention

(external beam radiation therapy) -Cleanse the skin daily by taking a lukewarm shower -Use mild soap without fragrance or deodorant

The FLACC scale

(face, legs, activity, cry, and consolability) can be used to assess pain in the child who is nonverbal

Craniofacial defects, including cleft lip and palate (eg, congenital anomalies)

, can be caused by maternal anticonvulsant use (eg, valproic acid)

Erythropoietin risk for?

- - administered intravenously or in any subcutaneous area (not intramuscularly).Hypertension is a major adverse effect of erythropoietin administration. Therefore, uncontrolled hypertension is a contraindication to recombinant erythropoietin therapy. Blood pressure should be well controlled prior to administering erythropoietin - Therapy should be discontinued or the dose reduced for hemoglobin >11 g/dL (110 g/L) to prevent venous thromboembolism and adverse cardiovascular outcomes from blood thickened by high concentrations of RBCs.

Fifth disease

- ("slapped face," or erythema infectiosum) is a viral illness caused by the human parvovirus and affects mainly school-age children. - The virus spreads via respiratory secretions, and the period of communicability occurs before onset of symptoms. - Once these children develop symptoms (eg, rash, joint pains), they are no longer infectious. Isolation is not usually required unless the child is hospitalized with aplastic crisis or immunocompromising condition

Methotrexate For? Cautions?

- (DMARD) to treat rheumatoid arthritis and psoriasis. - Folate antimetabolite, antineoplastic, immunosuppressant drug - Side effects: Bone marrow suppression, hepatotoxicity (ie, drug-induced liver injury), and gastrointestinal irritation (eg, nausea, vomiting, diarrhea). Can result in anemia, leukopenia, infection and thrombocytopenia - Hepatotoxic - avoid alcohol - Eye examination is contraindicated - Teratogenic

Holosystolic murmur

- (Heard during entire systole phase) - Classic sign of a ventricular septal defect (VSD) - Most close spontaneously within the first 6 moths of life

HELLP syndrome abbreviation stand for? s/s treatment and medication?

- (Hemolysis, Elevated Liver enzymes, and Low Platelet count) - RUQ pain, nausea, vomiting, and malaise(A general sense of being unwell, often accompanied by fatigue, diffuse pain, or lack of interest in activities.) Look for high blood pressure and protein in urine - Treatment - Best way is to deliver the baby, however if baby too preterm they try to look at lungs to see how mature it is - Contortionists to mature lungs - Magnesium sulfate to prevent seizures - Fetal monitoring, blood pressure medication, and blood transfusion if platelets low

Acetylcysteine For?

- (Mucomyst) - Via nebulizer to help loosen and liquefy respiratory secretions - For Cystic Fibrosis - Does not affect smooth muscle, only secretions - Can cause and/or worsen bronchospasm

Thrombolytic agents

- (eg, alteplase, tenecteplase, reteplase) - Contraindicated in clients with active bleeding, recent trauma, aneurysm, arteriovenous malformation, history of hemorrhagic stroke, and uncontrolled hypertension (blood pressure >180/110 mm Hg).

Calcium channel blockers

- (eg, diltiazem, verapamil, nifedipine, amlodipine, felodipine, nicardipine) - Antihypertensive - Causes Bradycardia - Dizziness (Option 2), flushing, headache, peripheral edema (Option 4), and constipation.

TNF(tumor necrosis factor) inhibitor drugs

- (eg, etanercept [Enbrel], infliximab [Remicade], adalimumab [Humira]) - reduce the manifestations of rheumatoid arthritis (RA) and slow the progression of joint damage by inhibiting the inflammatory response - causes immunosuppression and increased susceptibility for infection and malignancies. - have a baseline TST before initiating therapy and yearly skin tests thereafter. Those with latent tuberculosis (TB) must be treated with antitubercular agents before initiating treatment with these drugs. Otherwise, TB reactivation would occur

Aminoglycosides Side effects?

- (eg, gentamicin, tobramycin, amikacin) - antibiotics - Adverse effects: ototoxicity(ear) and nephrotoxicity(kidney) - Tinnitus and vertigo are early signs of ototoxicity - Superinfection - C. Diff and pseudomembranous colitis

Tricyclic antidepressant (TCA)

- (eg, imipramine, amitriptyline, nortriptyline) - Can produce cardiac toxicity and neurological disturbances - Urinary retention and glaucoma

ACE inhibitors cautions?

- (eg, lisinopril, ramipril, Catopril) - Antihypertensive - Cause hyperkalemia -Do not lower HR -Angioedema and cough is an adverse effect - Commonly in black - Teratogenic - contraindicated in pregnancy

Angiotensin II receptor blockers

- (eg, losartan, valsartan, candesartan) - Cause hyperkalemia - Black box warning - contraindicated during pregnancy

Nasoenteric tubes Cautions?

- (eg, nasoduodenal, nasojejunal) - placed using a stylet (guide wire), a metal wire running through the tube that facilitates advancement through the gastrointestinal tract. - After placement verification, the nurse should remove the stylet to allow tube feeding - never reinsert the stylet when a feeding tube is in place. - can cause perforation

Antiplatelet medication

- (eg, prasugrel [Effient], clopidogrel [Plavix], ticagrelor [Brilinta]) - Stopped 5-7 days prior to surgery

NSAID Precautions? What med is taken along with this usually?

- (naproxen, ibuprofen, indomethacin, celecoxib, ketorolac) - Can cause sodium retention - Increases the risk of thrombotic events (eg, heart attack, stroke) in clients with cardiovascular disease - Should be taken with a meal or snack to avoid gastric upset. - Cause problems for clients with asthma

Toilet training when?

- 18-24 months - Requires kid to be able to follow directions and communicate

Dissociative identity disorder

- 2 or more identities alternately control the client's behavior - alternate identities likely develop as a response to abuse or traumatic events and serve to protect the client from stressful memories - may not be aware of the alternate identities and may be confused by "lost time" and gaps in memory. - Switching between identities occurs as a reaction to stress and individual triggers. The goal of treatment is to integrate the identities into one personality while maintaining safety. - Dissociation and memory gaps are protective mechanisms. Forcing the client to hear or attempt to recall memories may result in distress and regression. Allow clients to recall memories at their own pace.

Thoracotomy drainage concerns

- 50-500ml of drainage expected within first 24 hours (bright red) - then change to serosanguineous (pink) followed by serous (yellow) - Dark blood is not a concern after 24 hours

Mean Arterial Pressure (MAP)

- 70-105 mm Hg - [Systolic Blood Pressure + (Diastolic Blood Pressure × 2)]/3

Rectal suppository

- <3 use fifth finger (Supine, hold buttocks together firmly after insertion Lift feet and knees) - >3 use index finger (Side lying position)

Guillain-Barré syndrome (GBS) What is it? What does it affect? Most life threatening complication? Gold standard for testing?

- A condition in which the immune system attacks the nerves - Affect- Ascending muscle weakness and absent deep-tendon reflexes - Compication- Neuromuscular respiratory failure is the most life-threatening complication. Inability to cough Shallow respirations Dyspnea and hypoxia Inability to lift the head or eyebrows - Gold standard- Forced vital capacity (spirometry) is the gold standard for assessing early ventilation failure.

Myelodysplastic syndrome s/s

- A group of bone marrow disorders caused in which the bone marrow does not produce enough healthy blood cells. - "bone marrow failure disorder" - Low white blood cell count, platelets, and hemoglobin are expected.

Phenylketonuria

- A low-phenylalanine diet - synthetic proteins and special formulas - Eliminating high-phenylalanine foods (eg, meats, eggs, milk) from the diet - consumption of natural foods low in phenylalanine (most fruits and vegetables)

Lung pneumonectomy intervention(lie on which side)

- A pneumonectomy is a type of surgery to remove one of your lungs because of cancer, trauma, or some other condition. - After surgery lie on affected site

Percutaneous coronary intervention (PCI)

- A small amount of bleeding/ecchymosis is expected at the access site due to anticoagulation therapy, which is initiated prior to PCI. The nurse should assess for signs of hematoma formation and retroperitoneal hemorrhage (eg, ecchymosis, flank/back pain) - The nurse should immediately notify the health care provider of postprocedure angina, which indicates possible thrombosis or stent occlusion

Autism spectrum disorder intervnetion

- A structured routine and consistency during hospitalization are critical

Esophagogastroduodenoscopy (EGD) Watch out for what after procedure?

- A sudden T spike after 1-2 hours may indicate sign of perforation or a developing infection - Notify HCP

Vaginal hematoma s/s

- A vaginal hematoma is a collection of blood that pools in the soft tissues of the vagina or vulva, which is the outer part of the vagina. - Severe vaginal pain or a feeling of fullness, and firm, midline uterine fundus

Phentolamine For?

- A vasodilator - Injected to counter adrenergic agonists (norepinephrine, dopamine)

Occupational therapy

- ADL (dressing, bathing, cognitive or perception issues) - above the waist - micromovements

Uterine rupture s/s

- Abnormal FHR patterns -Constant abdominal pain -Loss of fetal station -Sudden cessation of uterine contractions - Hemorrhage, hypovolemic shock, and maternal tachycardia may occur if severe rupture occurs

benign prostatic hyperplasia (BPH) what is it? increased risk for what? what meds can help inhibit further growth?

- Abnormal prostate enlargement that most commonly affects male clients age >50 - Increased risk for urinary tract infection (UTI) because of incomplete bladder emptying and urine retention - Finasteride (Proscar) is a medication that inhibits further growth of the prostate - Appreciable differences in prostate size are noticed only after several months of therapy. Missing three doses would not cause immediate or long-term adverse effects.

Neutropenia

- Absolute neutrophil count of <1000. - The client needs reverse or protective isolation - Until the room can be readied, the client should be protected with a mask and separated from infectious clients

Dopamine For? Side effects

- Adjunct to standard measures to improve: BP, Cardiac output, Urine output in treatment of shock unresponsive to fluid replacement. Increase renal perfusion (low doses). - Results in increased cardiac output, increased BP, and improved renal blood flow - Significant adverse effects include tachycardia, dysrhythmias, and myocardial ischemia. - Heart rate of 120/min - needs to reduce - Normal central venous pressure is 2-8 mm Hg; normal mean arterial pressure ([systolic blood pressure + (2 x diastolic blood pressure)]/3) is 70-105 mm Hg

Wound irrigation

- Administer the analgesic 30-60 minutes before the procedure - Don a gown and mask with face shield to protect from splashing fluid and sterile gloves to maintain surgical asepsis and prevent infection. - Fill a 30- to 60-mL sterile irrigation syringe with the prescribed irrigation solution. - Attach an 18- or 19-gauge needle or angiocatheter to the syringe and hold 1 in (2.5 cm) above the area. - Use continuous pressure to flush the wound, repeating until drainage is clear - Wounds should be cleaned from the least to the most contaminated area to prevent recontamination.

Addison disease s/s

- Adrenocortical insufficiency - Bronze hyperpigmentation - Vitiligo, or patchy/blotchy skin - Slow, progressive onset of weakness and fatigue -Anorexia and weight loss -Orthostatic hypotension -Hyponatremia and hyperkalemia -Salt cravings -Nausea and vomiting -Depression and irritability

Phototherapy

- Adverse effects from treatment, such as eye damage, dehydration, or sensory deprivation, can occur - the genital area is covered - The newborn may have loose green stools and green-colored urine. The newborn's skin color is monitored with the fluorescent light turned off every 4 to 8 hours and is monitored for bronze baby syndrome, a grayish brown discoloration of the skin. - After treatment, the newborn is monitored for signs of hyperbilirubinemia because rebound elevations can occur after therapy is discontinued.

arteriovenous fistula (AVF) Teaching

- After the AVF is placed, it takes 2-4 months for it to mature to accommodate the repeated venipunctures necessary for hemodialysis access - The major complications of an AVF are infection (especially in end-stage kidney disease and diabetes), stenosis, thrombosis, and hemorrhage. - Report numbness or tingling of the extremity to the HCP - Do not allow anyone (other than dialysis personnel) to draw blood or take blood pressure measurements on the extremity - Avoid wearing restrictive clothing or jewelry to prevent thrombosis - Do not use the arm with vascular access to carry heavy objects (more than 5 lb [2.26 kg]); however, exercises to increase strength could include squeezing a soft ball or sponge several times a day - Check the function of the vascular access several times a day by feeling for vibration to assess for patency, stenosis, and clotting - Do not sleep on the arm with vascular access or use creams or lotions on the site -

Billroth II (gastrojejunostomy) What is it? Complications and interventions afterwards

- Afterwards clients suffer dumping syndrome - Avoid fluids with meals and lie down after eating to slow gastric emptying - Eat food high in fat, protein, and fiber, which take more time to digest and remain in the stomach longer - Avoid meals high in simple carbohydrates, quick to digest thus dumping syndrome

Central venous catheter air leak Interventions

- Air embolism - Clamp the catheter Trendelenburg position on the left side Administer O2 Notify HCP

Cervical cancer risk factors

- Almost all cases of cervical cancer result from persistent infection due to human papillomavirus (HPV), a primary risk factor - Clients who have multiple sexual partners or initiate sexual activity at an early age (<18) increase their risk for exposure to HPV - Clients with weakened immunity (eg, HIV, immunosuppressive therapy) may have an impaired ability to clear HPV, which increases the risk for cervical cancer due to persistent infection - Table: Infection with HPV History of sexually transmitted diseases Early onset of sexual activity Multiple or high-risk sexual partners Immunosupression Oral contraceptive use Low socioeconomic status Tobacco use

Terazosin For? Precautions?

- Alpha-adrenergic blocker that can relieve urinary retention in clients with BPH - relaxes the smooth muscle - Change position slowly - Some clients may also experience ejaculatory dysfunction (decreased or absent ejaculation) - Avoid phosphodiesterase-5 inhibitors [sildenafil or vardenafil] used to treat erectile dysfunction

Benzodiazepines Side effects? Antidote?

- Alprazolam [Xanax], Lorazepam [Ativan], Clonazepam, Diazepam - Side effects can include airway occlusion, apnea, hypotension (especially in the presence of an opioid), and oxygen desaturation with resultant respiratory arrest. - Antidote - Flumazenil - Never stopped abruptly

Ziprasidone hydrochloride For? Precautions?

- An atypical antipsychotic drug that is used for acute bipolar mania, acute psychosis, and agitation - Risk for QT prolongation leading to torsade de pointes - Monitored for hypotension and seizures

myasthenia gravis (MG) What is it? complications? First line drug? What can precipitate life-threatening crisis? s/s of crisis?

- An autoimmune disease in which antibodies attack acetylcholine receptors - Affects skeletal muscles - causes weakness - Involves eye movement, swallowing/speaking, and breathing - Ptosis is normal - Pyridostigmine first-line drug against weakening of respiratory muscles. Given before meals - Infection, undermedication, and stress can precipitate a crisis - Crisis - oropharyngeal and respiratory muscle weakness and respiratory failure

percutaneous endoscopic gastrostomy (PEG) tube

- An expected finding that indicates appropriate device function is slight in-and-out movement of the PEG tube (ie, ≤0.25 in [≤ 0.6 cm]), especially when coughing - secured loosely against the skin, - There should be no resistance when rotating the device

Pneumonia s/s

- An inflammation of lung tissue, wherer the alveoli in the affected areas fill w/fluid - Crackles, dyspnea, and pleuritic chest pain - Increased vocal/tactile fremitus (Transmission of palpable vibrations (fremitus) is increased when transmitted through consolidated versus normal lung tissue) - Bronchial breath sounds in peripheral lung fields (early signs) - Unequal chest expansion - Dullness - If left sided lie down on right side

Ankylosing spondylitis s/s ? what can happen? intervention?

- An inflammatory disease affecting the spine, has no known cause or cure - s/s Restricted spinal mobility Low back pain and morning stiffness that improve with activity Can limit chest wall expansion, leading to hypoventilation - Intervention - proper posture, daily stretching, Stop smoking and practice breathing exercises, moist heat and NSAIDs - rest during flare-ups - sleep on a firm mattress

Linezolid (Zyvox) For? Cautions?

- Antibiotic - For vancomycin- and methicillin-resistant bacteria, pneumonia, and skin infections - Has monoamine oxidase inhibitor (MAOI)-type properties; concurrent use with selective serotonin reuptake inhibitors (SSRIs) (eg, paroxetine, fluoxetine, sertraline) increases the risk of serotonin syndrome, a potentially fatal accumulation of serotonin

Nystatin For? Teaching?

- Antifungal - To treat mucocutaneous candidal infections - If wearing dentures - soak them in nystatin to kill all those bacteria -A Liquid suspension for oral thrush to swish the suspension in the mouth for several minutes and then swallow the medication to allow treatment of any esophageal candida - Shaken well before being measured

Clozapine For? Complication?

- Antipsychotic medication used to manage schizophrenia - Life-threatening adverse effects, including agranulocytosis, cardiac disease (myocarditis), and seizures - Risk for infection - Drooling and salivation is common

Criteria for activating the rapid response team

- Any staff members is worried about the client's condition OR - An acute change in any of the following HR <40 or >130 Systolic BP <90 Respiratory rate <8 or > 28 Oxygen saturation <90% despite oxygen Urine output <50 ml in 4 hours Level of consciousness

When chest tube dislodged from patient Interventions?

- Apply occlusive dressing and tape 3 sides only - After taking out chest tube - post-procedure chest x-ray is necessary

Aortic dissection s/s ? contributing factor? at risk for?

- Arterial wall intimal layer tears and allows blood between the inner (intima) and middle (media) layers - "worst ever," "tearing," or "ripping" pain; radiates to the back - Hypertension is a contributing factor - Risk of aortic rupture - Maintain normal BP - IV Beta blockers help lower BP and HR

Moving with a cane

- Ascending: Step up with the stronger leg first (in this client, the right leg) Move the cane next while bearing weight on the stronger leg Finally, move the weaker leg (in this client, the left leg) - Descending: Lead with the cane Bring the weaker leg down next Finally, step down with the stronger leg -The nurse may use the mnemonic "up with the good and down with the bad." The cane always moves before the weaker leg.

Blood transfusion Preparation? S/S of complication? Intervention during and after complication?

- Ask client to void prior to starting transfusion (In the event of an acute hemolytic transfusion reaction, a fresh urine specimen should be collected and sent to the laboratory to analyze for hemolyzed RBCs) - Early signs of a hemolytic reaction include red urine, fever, and hypotension -Interventions during complications: Stop the transfusion immediately Using new tubing, infuse normal saline to keep the vein open . Continue to monitor hemodynamic status and notify the health care provider and blood bank. Administer any emergency or prescribed medications to treat the reaction; these may include vasopressors, antihistamines, steroids, or IV fluids Collect a urine specimen to be assessed for a hemolytic reaction Document the occurrence and send the remaining blood and tubing set back to the blood bank for analysis

Endoscopic retrograde cholangiopancreatography(ERCP) at risk for?

- Assess the pancreatic and biliary ducts. Using fluoroscopy with contrast media, the ducts can be visualized and treatments including removal of obstructions, dilation of strictures, and biopsies can be performed. - Perforation or irritation of these areas during the procedure can cause acute pancreatitis, a potentially life-threatening complication after an ERCP. Signs and symptoms include acute epigastric or left upper quadrant pain,

Hyperosmolar hyperglycemic state s/s

- Associated with type 2 DM - still Enough insulin to prevent DKA - thus no Kussmaul respiration -extreme hyperglycemia, osmotic diuresis, and extracellular fluid deficit. - Neurological manisfestation - often >600 mg/dL (33.3 mmol/L).

Systemic lupus erythematosus (SLE) s/s? what can exacerbate SLE Serious complication of SLE? Drug?

- Autoimmune disorder in which an abnormal immune response leads to chronic inflammation of different parts of the body. - Most experience painful/swollen joints, extreme fatigue, skin rashes(butterfly shaped rash of face), and kidney problems - Has periods of remissions - Physical and emotional stress can exacerbate SLE - Increased creatinine, blood urea nitrogen, and an abnormal urinalysis (eg, protein, red blood cells, cellular casts) can indicate the presence of lupus nephritis (occurring in 50%), a potentially serious complication of SLE. - Hydroxychloroquine (Plaquenil)- Several months before effects; Retinal toxicity and visual disturbances(eye examination q 6 months). It's are DMARD

Huntington disease (Huntington chorea) s/s ?

- Autosomal dominant - Progressive nerve degeneration, which results in impaired movement, swallowing, speech, and cognitive abilities - Chorea is hallmark (involuntary, tic-like movement) - Death from neuromuscular and respiratory complications

Seventh Day Adventists (church of god)

- Avoidance of overeating (no snacks in between meals) - 5-6 hours must past between meals - coffee and alcohol is prohibited - most are lacto-ovo - if they do it meat, they avoid pork - meals must be delivered on a timely fashion

Preconception education

- BMI - 18.5-24.9 - Daily intake of 400mcg of folic acid - Dental wellness

Medication error what to do?

- Before taking any other actions, the nurse must ensure that the client is safe - Following client stabilization, the error should be reported to the appropriate nursing authority (eg, supervisor, manager), and an incident or occurrence report should be filed within 24 hours

Lead poisoning

- Blood lead level (BLL) screenings are recommended at ages 1 and 2, and up to age 6 if not previously tested. - Affects the neurological system, elevated BLLs (≥5 mcg/dL [0.24 µmol/L]) are dangerous in young children due to immature development of the brain and nervous system. A mild to moderate increase in BLL can manifest with hyperactivity and impulsiveness; prolonged low-level exposure can cause developmental delays, reading difficulties, and visual-motor issues. Extremely elevated BLLs can lead to permanent cognitive impairment, seizures, blindness, or even death.

Hirschsprung disease - s/s? - can lead to? s/s of that complication?

- Bowel obstruction is caused by failure of the internal sphincter to relax - s/s Thin, ribbon-like stool (congenital aganglionic megacolon) Bilious vomiting, abdominal distension, failure to pass meconium, - Lead to - Fatal complication is Hirschsprung enterocolitis, an inflammation of the colon, which can lead to sepsis and death - Fever; lethargy; explosive, foul-smelling diarrhea; and rapidly worsening abdominal distension

Beta blockers

- Bradycardia - Cause problems for clients with asthma (bronchospasm) - bradycardia, bronchospasm, depression, and decreased libido with erectile dysfunction.

Hypothyroidism s/s at risk for?

- Bradycardia and hypotension Hypothermia and cold intolerance Constipation Fragile, dry skin and hair loss Forgetfulness, slurred speech, and confusion - Myxedema coma - severe hypothyroidism causing decreased level of consciousness (eg, lethargy, stupor) that may progress to a comatose state. -hypothermia, bradycardia, hypotension, and hypoventilation -Clients with signs of respiratory failure (eg, slow or shallow breathing, low oxygen saturation) require emergency endotracheal intubation and mechanical ventilation. The nurse should provide respiratory support (eg, ventilation with a bag-valve-mask) and prepare to assist with intubation

Theophylline For? Cautions?

- Bronchodilator - Low therapeutic index - >20 toxic - Cause seizures and life-threatening arrhythmias - Cimetidine and ciprofloxacin can dramatically increase serum theophylline levels (>80%)

Opioid agonist-antagonist Precautions during labor?

- Butorphanol tartrate(Stadol) and Nalbuphine hydrochloride (Nubain) - Crosses the placental barrier, peaks 30-60 min, and duration is 2-4 h - If given near time of birth - risk for newborn respiratory depression

Infants When can they roll over? When can they sit up from prone position? When can they pull themselves up to standing position? Walking while holding onto furniture? When can they bear full weight on legs with support of a caregiver?

- By age 7 months, infants can roll over, but the ability to move from a prone to a sitting position is not expected until age 10 months. - Some infants learn to pull themselves up into a standing position early, but this is not expected until age 9-10 months. - Walking while holding on to furniture is not expected until age 11 month - By age 7 months, infants should be able to bear their full weight while standing with caregiver support and sit with minimal support from their hands

ECT

- CT can be highly effective in helping severe depression, when clients pose a severe threat to themselves and it is not safe to wait until medications take effect. ECT is also used in clients who have not responded to medication or cannot tolerate side effects. - the electrical stimulus is sufficient to cause a brief convulsion. General anesthesia and a skeletal muscle relaxant are administered to minimize the motor seizure and prevent musculoskeletal injury. The client feels nothing from the procedure, but confusion and memory loss are common side effects.

IV vancomycin Side effect?

- Can cause Red man syndrome - flushing, erythema, and pruritus -Muscle pain, spasms, dyspnea, and hypotension -IV rate related. Slow down

Pancreatic enzyme supplement

- Capsule contents may be sprinkled on applesauce, yogurt, or acidic, soft, room-temperature foods with pH <4.5. - Capsules should be swallowed whole and not crushed or chewed; chewing the capsules could cause irritation of the oral mucosa. - Capsules should not be taken with milk as they can cause it to curdle.

Oxytocin Too much can cause?

- Category II or III fetal heart rate (FHR) patterns (eg, late decelerations, bradycardia). Abnormal or indeterminate FHR patterns - Emergency cesarean birth, which may be required due to persistent abnormal FHR pattern - Postpartum hemorrhage - Water intoxication - Oxytocin has an antidiuretic effect when administered at high doses over prolonged periods. - Uterine tachysystole (ie, >5 contractions in 10 minutes) - increased risk for placental obruption and uterine rupture

Infectious mononucleosis What is it caused by? S/S ? Most serious complication?

- Caused by the Epstein-Barr virus - Fatigue, fever, sore throat, splenomegaly, swollen lymph nodes. - Spleen rupture is a serious complication - Airway obstruction from swollen lymph nodes

Rotavirus route of transmission? what does it cause?

- Causes diarrhea - Fecal oral route

Common causes of SIADH

- Central nervous system disruption (eg, stroke, trauma, neurosurgery) - Malignancies (eg, small cell lung carcinoma) - Drugs (eg, desmopression, !carbamazepine!) - Pulmonary disorders (eg, pneumonia) - Some cancer cells, particularly those of small cell lung cancer, have the ability to produce and secrete ADH, leading to SIADH

Cyclobenzaprine For? Precautions?

- Centrally acting skeletal muscle relaxant prescribed for muscle spasticity, muscle rigidity, and acute or chronic muscle pain/injury. - muscle relaxants are metabolized by the liver. The presence of liver disease (eg, hepatitis) decreases hepatic metabolism and can cause a buildup of medication, leading to medication toxicity and increased CNS depression (eg, weakness, confusion, drowsiness, lethargy)

Cirrhosis s/s what medication what conditions can precipitate hepatic encephalopathy

- Chronic degenerative disease of the liver - Is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism. Each time your liver is injured — whether by disease, excessive alcohol consumption or another cause — it tries to repair itself - S/S-Spider angiomas (The lesion contains a central, red spot and reddish extensions which radiate outward like a spider's web) - Cholestyramine (Questran) may be prescribed to increase the excretion of bile salts in feces - 1 hour after all medication - Hypokalemia, high protein intake, gastrointestinal bleeding, constipation, hypovolemia, and infection can precipitate hepatic encephalopathy

Ulcerative colitis s/s dietary interventions

- Chronic inflammation of the colon with presence of ulcers - Abdominal pain, frequent bouts of bloody diarrhea, anorexia, and anemia - High calorie and protein Multivitamins Oral hydrations ( >10 liquid stools may occur daily during flares) Journaling dietary triggers Avoid gastric irritants (coffee etc.) or gas producing food

Residual limb care

- Clean the limb by washing it daily with soap and warm water - Thoroughly inspect the limb for signs of infection (eg, redness) and areas that may be at risk for infection (eg, irritation, skin breakdown) - Keep limb socks, wraps, and appliances/prostheses clean and dry - Perform daily range-of-motion exercises to improve muscle strength and mobility. - Hip flexion contractures are a common complication during the recovery process. Nurses should teach clients to lie prone several times each day and to avoid sitting in a chair for ≥1 hour

Liver biopsy interventions afterwards

- Client lies supine with right arm over the head and holding the breath - Lie on the right side for 2-4h to splint incision site - Not necessary to empty bladder before procedure

Romberg sign need help with what?

- Clients are asked to stand with the feet together and hands at the sides of the body. They are then asked to close their eyes while ability to maintain balance is assessed. -A loss of balance is considered to be a positive Romberg sign and indicates that ataxia is sensory in nature rather than cerebellar - Prone to lose balance, and would require assistance with ambulation.

postoperative cognitive dysfunction(POCD)

- Clients who have undergone surgery (eg, coronary artery bypass graft) may experience - This may include memory impairment and problems with concentration, language comprehension, and social integration. Some clients may cry easily or become teary. - The risk for POCD increases with advanced age

Assessment of mechanical capture of a pacemaker

- Clients with an implanted permanent pacemaker should be assessed for both electrical capture of heart rhythm and mechanical capture of heart rate - In atrial pacing, pacer spikes precede P waves, whereas in ventricular pacing, pacer spikes precede QRS complexes. - The best method for checking for a pulsatile rhythm is to assess a central pulse (eg, auscultation of apical, palpation of femoral) - This rate should be compared to the electrical rate displayed on the cardiac monitor to assess for pulse deficit.

Peritoneal dialysis s/s of complicatoin? Insufficient outflow - interventions?

- Cloudy outflow, tachycardia, and low-grade fever - Bloody - intestinal perforation or menstruation - Brown indicate fecal contamination - Insufficient outflow: Most often from constipation (give stool softeners) Check the tubing for kinks and reposition the client to a side-lying position or assist with ambulation Assess for fibrin clots and milk the tubing to dislodge or administer fibrinolytics (eg, alteplase) as prescribed If none work use x-ray to check position

Bupropion and Varenicline For? Side effects?

- Commonly prescribed for smoking cessation - Can cause serious neuropsychiatric effects (eg, depression, suicide);

St. John's wort

- Commonly used by many clients to treat depression - Interact with medications used to treat depression - seretonin syndrome

Patent ductus arteriosus (PDA) s/s ?

- Connection between aorta and pulmonary artery - Machine like murmur

After lumbar puncture

- Continued leaking fluid indicates that the site did not seal off and a blood patch (autologous blood into the epidural space) is required. - Up to 5%-30% of clients have the common complication of headache. It is thought to be a result of leakage of fluid through the dural puncture site. The symptom is treated and is normally self-limiting.

Transurethral resection of the prostate Intervention afterwards?

- Continuous bladder irrigation (CBI) with a 3-way Foley catheter is initiated after the procedure - During the first 24 hours, the urine color changes from reddish-pink to pink - The nurse should adjust the irrigation rate with these normal findings so that the urine remains light pink without clots

Salem pump Residual check

- Continuous suctioning for decompression - don't check for residual - Don't plug air vent when gastric content refluxes 10-20 ml of air can be injected into the air vent

Cervical cap How is it used? Risk for?

- Contraception used with spermicide - In place for ≥6 hours after intercourse but should not remain for more than 48 hours - Inserting the cervical cap several hours before intercourse is acceptable and may improve correct use - Use of cervical caps during menses (or during the postpartum period in clients with lochia discharge) increases the risk of toxic shock syndrome

Rheumatoid arthritis management

- Contracture of ligaments and joint remodeling may occur, resulting in weakness and deformity. Clients with RA require education on prevention of disease progression, including: - Joint protection - Fibrosis from RA can shorten tendons and ligaments when joints are flexed for prolonged periods. Body aligners or immobilizers should be used when resting to keep extremities straight (especially with advanced disease). - Medications - RA is often treated using a regimen of disease-modifying antirheumatic drugs (eg, methotrexate), and clients should take their medication as prescribed regardless of symptoms

Iron supplements

- Dairy products should be consumed at least 2 hours before or 1 hour after iron supplements - Don't take with food - It stains teeth so administer through a straw or a medicine dropper - Brush or wipe teeth after administration

Third-degree atrioventricular(AV) block s/s can lead to? interventions?

- Decreased cardiac output (eg, dizziness, syncope, mental status changes, heart failure, hypotension, bradycardia) - May decompensate to cardiogenic shock and even periods of asystole - Administration of atropine and temporary pacing (eg, transcutaneous) until a permanent pacemaker can be placed

Dental avulsion

- Dental avulsion (ie, tooth separated from the mouth) of a permanent tooth is a dental emergency - The priority nursing action is to rinse and reinsert the tooth into the gingival socket and hold it in place (eg, with a finger) until stabilized by a dentist

Troponin

- Detection of MI - Normal values: troponin I <0.5 ng/mL (<0.5 mcg/L); troponin T <0.1 ng/mL (<0.1 mcg/L).

Serotonin Syndrome s/s?

- Diaphoresis, agitation, tachycardia, autonomic instability and hypertension, diarrhea and hyperactive bowel sounds, mydriasis(dialated pupils), hyperrflexia, clonus, tremor

Tube feeding s/s of complications

- Diarrhea: May occur if tube feeding formula is too concentrated (hyperosmolar) or administered too rapidly - Fluid overload: Manifested as rapid weight gain and peripheral edema - Nausea and vomiting: Due to delayed gastric emptying or rapid administration - The recommended target serum glucose range for clients receiving nutritional support is 140-180 mg/dL (7.8-10.0 mmol/L). Hyperglycemia (>180 mg/dL [10.0 mmol/L]) would require interventio

PTSD s/s?

- Difficulty concentrating, feeling detached from others, flashbacks of the traumatic event, persistent angry, fearful mood

Digoxin vs Dopamin

- Digoxin is a positive inotropic drug (improves contractility) used in long-term treatment of heart failure. - Dopamine, a positive inotropic drug, is used as a short-term treatment for ADHF; however, it does not resolve the fluid overload affecting oxygenation.

Hepatitis B

- Disease of the liver characterized by inflammation, necrosis, and cirrhosis - Contact with blood, semen, and vaginal secretions - Jaundice - Elevated amylase and lipase enzymes

Myocardial ischemia s/s s/s in women and older adults or clients with diabetes

- Dizziness, sweating or cold, clammy skin, SOB, ischemic chest pain, nausea and vomiting, - pain radiation: neck, jaw, left shoulder, arms and epigastrium - women etc - atypical presentations (eg, indigestion, jaw/shoulder pain, dyspnea, diaphoresis, nausea/vomiting) other than chest pain during a myocardial infarction

Boston brace, Wilmington brace, thoracolumbosacral orthosis (TLSO) brace, and Milwaukee brace - Interventions? - Contraindications?

- Do not cure the existing spinal deformities but do prevent further worsening. - Cotton t-shirt under the brace to decrease skin irritation and absorb sweat - Worn 18-23 hours per day and removed for bathing and exercise. - Do exercises that build spine muscles - Don't (lotion or powder can cause skin irritation due to heat buildup beneath the brace)

Increased ICP

- Don't raise head with several pillows. - may flex the neck, decrease venous drainage, and increase ICP.

Triple lumen catheter - how to flush unsused lumens? - which lumen for TPN? - how often change occlusive dressing?

- Doses 2-3 ml of 10 units/ml - 100 units/ml of heparin used to flush unused lumens. - TPN administered through a CVC - According to CDC - change occlusive dressing every 7 days

IV vancomycin

- Draw the prescribed trough level prior to administration. Adverse effects of vancomycin toxicity include nephrotoxicity (eg, elevated creatinine levels) and ototoxicity (eg, hearing loss, vertigo, tinnitus). - Infuse medication over at least 60 minutes (≤10 mg/min). Faster rates increase the likelihood of complications - Monitor blood pressure during the infusion. Hypotension is a possible adverse effect - Assess for hypersensitivity. Red man syndrome is a nonallergic histamine reaction characterized by sudden onset of severe hypotension, flushing, and/or maculopapular rash of the face, neck, chest, and upper extremities - Monitor for anaphylaxis (eg, rash, pruritus, laryngeal edema, wheezing). - Observe IV site every 30 minutes for pain, redness, or swelling. Vancomycin is a vesicant and may cause thrombophlebitis or, if extravasation occurs, tissue necrosis. Administration using a central venous catheter is preferred; however, a peripheral IV may be used for short-term therapy

Beers Criteria

- Drugs dangerous for geriatric patients - Antipsychotics, anticholinergics, antihistamines(-mine), antihypertensives, benzodiazepines, diuretics, opioids, and sliding insulin scales

Postoperative At risk for? What to do when they feel nauseated?

- Due to altered level of consciousness - at risk for aspiration - Client reporting increased nausea - immediately placed on their side to prevent aspiration

Overflow urinary incontinence intervention?

- Due to compression of the urethra or impairment of the bladder muscle - Incomplete bladder emptying and urinary retention -> dribbling - Fixed schedule, Use Valsalva maneuver(bearing down) and Crede maneuver(gently applying pressure to the lower abdomen, After first voiding, wait 30s and void again

Torsade de pointes

- Due to hypomagnesemia - The first-line treatment is IV magnesium

Catatonia s/s? at risk for?

- During schizo - Immobility - Remains mute - Bizarre postures - the client holds the body rigidly in one position - Extreme negativism - the client resists instructions or attempts to be moved - Waxy flexibility - body stays in position someone else put them into Staring - High risk for dehydration and malnutrition

Roux-en-Y gastric bypass (RYGB) Postoperative interventions?

- Eat small meals, eat a low-carbohydrate diet, and separate their consumption of food and fluids - Risk for cobalamin deficiency. The client will need parenteral or intranasal cobalamin replacement

Hip fractures include

- Ecchymosis and tenderness over the thigh and hip - Groin and hip pain with weight bearing - Muscle spasm in the injured area - Shortening of the affected extremety - Abduction or adduction of the affected extremety and externally rotated

Oxytocin IV Risk for?

- Electronic infusion pump - risk of hypotension - Intake and output monitoring - water intoxication

Reye syndrome due to? s/s

- Encephalopathy and liver damage in children following an acute viral illness; linked to aspirin use - Often from aspirin usage during viral infection - varicella or influenza - Fever, lethargy, acute encephalopathy, and altered hepatic function. Elevated serum ammonia levels are an expected laboratory finding

Sickle cell crisis serious complications?

- Enlarged spleen is an emergency - Priapism - painful erection >2 hours - Don't give meripidine for pain - because of the risk for normeperidine-induced seizures

SSRI Watch out for?

- Escitalopram, citalopram(Celexa), sertraline (Zoloft), fluoxetine, paroxetine - Therapeutic effects in 1-4 weeks - increased energy without a change in depressive feelings needs to be assessed - suicide plan makes them energetic again

Open abdominal aneurysm repair Key assessment preoperatively??

- Establishing baseline data is essential for comparison with postoperative assessments. The nurse should pay special attention to the character and quality of peripheral pulses and renal and neurologic statu

Tamoxifen For? Precautions?

- Estrogen receptor modulator - Treat certain breast cancer and prevent breast cancer recurrence - Watch out for occuring side effect or history of thromboembolic events and endometrial cancer (abnormal vaginal bleeding)

Cushing syndrome s/s?

- Excess corticosteroid - Purple striae (stretch marks) - Hirsutism (increased facial and body hair) - Supraclavicular fat pad (ie, buffalo hump)

Meniere disease s/s treatment and risks for?

- Excess fluid accumulation inside the inner ear - Episodes of vertigo, tinnitus, hearing loss, and aural fullness - nausea and vomiting may result - Fall risk - Salt restriction to prevent fluid buildup in the ear

Hyperthyroidism s/s? trigger? management? risk for? Disease? Primary treatment?

- Excessive activity of the thyroid gland - Fever, tachycardia, cardiac dysrhythmias (eg, atrial fibrillation; common in Graves disease also, not a defining feature of thyroid storm, thus look for altered mentation or fever), nausea, vomiting, diarrhea, and altered mental status, hypertension - Triggered during stressful situations - Management- reducing fever, maintaining hydration, and preventing cardiac compromise (eg, heart failure) - Risk for - Thyroid storm - Grave's disease - Radioactive iodine (RAI) is primary treatment - Harms fetus - Eyelid lag (ie, Graefe's sign) is a delayed movement in the eyelid when the eye looks downward

Crutches

- Excessive and prolonged pressure on the axillae can cause localized damage to the radial nerve at the axilla - crutch paralysis, or palsy, which manifests as muscle weakness and/or sensory symptoms (tingling, numbness) of the arm, wrist, and hand.

Client with chest tube assess

- Excessive drainage (>100ml/hr) - Pain, infection, air/fluid in chest(diminished breath sounds) - Collection chamber check q8h - Q1h for first 8h of surgery

Hyperemesis gravidarum

- Excessive vomiting that result in dehydration - Expected findings include an elevated urine specific gravity and ketonuria - Urine specific gravity increases when urine is concentrated due to dehydration, and ketones are a byproduct of the fat breakdown that occurs in starvation states

Coronary artery bypass grafting (CABG) Discharge instructions

- Explain the need for modification of cardiac risk factors, including smoking cessation, weight reduction, maintaining a healthy diet, and increasing activity levels through exercise. - Encourage a daily shower as a bath could introduce microorganisms into the surgical incision sites. Surgical incisions are washed gently with mild soap and water and patted dry. The incisions should not be soaked or have lotions or creams applied as this could introduce pathogen - Explain that light house work may begin in 2 weeks, but there is to be no lifting of any object weighing >5 lb (2.26 kg) without approval of the HCP Lifting, carrying, and pushing heavy objects are isometric activities. Heart rate and blood pressure increase rapidly during isometric activities, which should be limited until approved by the HCP, generally about 6 weeks after discharge. Guide the client to gradually resume activity and possibly participate in a cardiac rehabilitation program - Clarify no driving for 4-6 weeks or until the HCP approves. - If the client is able to walk 1 block or climb 2 flights of stairs without symptoms (eg, chest pain, shortness of breath, fatigue), it is usually safe to resume sexual activity - Notify the HCP if the following symptoms occur: Chest pain or shortness of breath that does not subside with rest Fever >101 F (38.3 C) Redness, drainage, or swelling at the incision sites

Septic shock s/s

- Fever or hypothermia - Hypotension - Systolic blood pressure <90 mm Hg or mean arterial pressure <65 mm Hg - Prolonged capillary refill - Tachycardia - WBC count >12,000/mm3 (12 x 109/L) or immature neutrophils (bands) of >10%

Peritoneal dialysis common complication

- Fialysis in which the lining of the peritoneal cavity acts as the filter to remove waste from the blood - Peritonitis - inflammation of the peritoneum - s/s of peritonitis - cloudy peritoneal effluent (early), and Rebound tenderness (late) - Watch out for respiratory distress resulting from too rapid instillation of dialysate, overflowing outside the abdomen and resulting in difficulty breathing, rapid respirations, crackles

Colostomy irrigation steps?

- Fill the irrigation container with 500-1000 mL of lukewarm water, flush irrigation tubing, and reclamp; hang the container on a hook or intravenous pole - Instruct the client to sit on the toilet, place the irrigation sleeve over the stoma, extend the sleeve into the toilet, and place the irrigation container approximately 18-24 inches above the stoma - Lubricate cone-tipped irrigator, insert cone and attached catheter gently into the stoma, and hold in place - Slowly open the roller clamp, allowing irrigation solution to flow for 5-10 minutes - Clamp the tubing if cramping occurs, until it subsides - Once the desired amount of solution is instilled, the cone is removed and feces is allowed to drain through the sleeve into the toilet

Hyperkalemia

- First step - Intravenous calcium gluconate is administered to hyperkalemic clients with ECG changes (eg, peaked T waves). - Calcium gluconate itself does not decrease the serum potassium level but temporarily stabilizes the myocardium by raising the threshold for dysrhythmia occurrence.

Pregnancy weight gain

- First trimester 1/1-4/4 lb - Second and third trimesters under/normal weight - 1lb/wk overweight - 0.6lb/wk obese - 0.5lb/wk

Fleet enema x Neomycin enema

- Fleet enema - relieves constipation - Neomycin enema - reduces the number of bacteria in the intestine in preparation for colon surgery

Fat embolism S/S?

- Follows long bones and pelvis fractures - Leads to cerebral injury - A hallmark sign of fat emboli is the presence of petechiae (pin-sized red/purple spots) that result from small-vessel clotting and appear across the neck, chest, and axilla - Respiratory problems (eg, dyspnea, tachypnea, hypoxemia) - Neurologic changes (eg, altered mental status, confusion, restlessness) - Fever

Long-term corticosteroids Watch out for?

- For Addison's disease - Do not discontinue abruptly -It is immunosuppressive - report any signs of infection -During stress - increase dose -Report hyperglycemia -Affect bone(osteoporosis) and muscle (weakness) -Cataracts are a side effect -Report s/s of Cushing syndrome

Pap testing

- For HPV - Cervical cancer screening is typically initiated at age ≥21, regardless of age at onset of sexual activity(so if under 21 and already sexually active, don't need pap test until 21). Women age 21-29 should be screened with Pap testing every 3 years

Carbidopa-levodopa Cautions?

- For Parkinson disease (PD) - Symptoms (such as shakiness, stiffness, difficulty moving). Parkinson's disease is thought to be caused by too little of a naturally occurring substance (dopamine) in the brain - Fall precautions - Takes several weeks to reach its maximum effectiveness -Harmless discoloration (eg, red, brown, black) of secretions (eg, urine, perspiration, saliva) -Avoiding high-protein meals, which interfere with the absorption of carbidopa-levodopa -Dyskinesia (eg, facial or eyelid twitching, tongue protrusion, facial grimacing) may indicate overdose or toxicity of carbidopa-levodopa - Treats bradykinesia (generalized slowing of movement) - Never be stopped suddenly - Prolonged use can also result in dyskinesias (spontaneous involuntary movements)

Ethambutol (Myambutol) For? Side effect?

- For TB - Can cause ocular toxicity - vision loss or color problems - Vission test regularly

Lithium Common symptoms? Acute x Chronic toxicity? What can precipitate toxicity? Prevention of toxicity?

- For bipolar - 0.6 - 1.2 (>1.5 is considered toxic) - Dry mouth and thirst is common; may take up to 3 weeks to become effective - Toxicity occurs with dehydration, hyponatremia, decreased renal function, and drug-drug interactions (eg, nonsteroidal anti-inflammatory drugs, thiazide diuretics) - Clients with vomit/diarrhea - low Na -> toxicity - Acute toxicity - Gastrointestinal findings - nausea. vomiting, diarrhea, neurologic findings occur later - Chornic toxicity - Neurologic - ataxia, sluggishness, confusion, agitation, neuromuscular excitability (coarse tremor) - Avoid sodium depletion; low sodium intake precipitates lithium toxicity - Eat regular diet & drink adequate fluids (2-3 L/day)

Botulinum toxin A risk ?

- For cosmetic purposes - for facial and neck rejuvenation - Can relax muscles used for swallowing and breathing\

Severe neck spasm med?

- For people taking antipsychotic - dystonic reaction - Need IV benztropine(Cogentin)

Permethrin

- For scabies - Put onto all skin surfaces (not just the area with the rash) - should not be applied until at least 30 minutes after bathing and should be applied only to cool, dry skin

Bariatric surgery contraindications

- For weight loss involves a surgical modification of the client's stomach and/or small intestine to restrict the client's intake - Nasogastric tubes are contraindicated - hemorrhage and anastomotic leak -

Rifampin (Rifandin) For? Side effect?

- For? - Hepatotoxicity - Changes color of body fluids - use glasses instead of lenses - Women should use non hormonal birth control (decreases effectiveness of contraceptives)

Paraphimosis

- From condom catheter - Uncircumcised male foreskin cannot be returned (reduced) to its original position,

Esophageal atresia and tracheoesophageal fistula s/s risk for?

- Frothy saliva, coughing, choking, and drooling - Apnea and cyanosis during feeding - Aspiration is the greatest risk

GTPAL system for obstetric history notation

- G - Gravida - The signs are acute mental status changes that fluctuate and inattention with disorganized thinking and/or altered level of consciousness. The disorganized thinking includes hallucinations - T-term - The signs are acute mental status changes that fluctuate and inattention with disorganized thinking and/or altered level of consciousness. The disorganized thinking includes hallucinations - P - Preterm - The signs are acute mental status changes that fluctuate and inattention with disorganized thinking and/or altered level of consciousness. The disorganized thinking includes hallucinations - A - Abortion - The signs are acute mental status changes that fluctuate and inattention with disorganized thinking and/or altered level of consciousness. The disorganized thinking includes hallucinations - L - Living - The number of currently living children

Total parenteral nutrition (TPN)

- Glucose (dextrose) is a primary component of TPN solutions - assess for symptoms of hyperglycemia (eg, polydipsia, polyuria, headaches, blurred vision)

Meconium aspiration syndrome s/s ? risk for?

- Green amniotic fluid indicates that the fetus has passed its first stool (meconium) in utero - Risk for aspiration

Put on PPE steps

- Hand hygiene - Gown - Mask or respirator - Goggles or face shield - Gloves

Pediculosis Capitis - med? clothes?

- Head lice - Nits - eggs - kill those pediculicide (usually permethrin 1% cream) to the head and removing nits with a nit comb or by hand Non-washable items can be sealed in a plastic bag for 14 days to kill lice

cystic fibrosis (CF) autosomal what? risk?

- Hereditary disorder of the exocrine glands characterized by excess mucus production in the respiratory tract, pancreatic deficiency, and other symptoms - Autosomal recessive - Risk for recurrent lung infections. - Risk for rupture of the damaged alveoli, which results in sudden-onset pneumothorax (Sudden worsening of dyspnea, tachypnea, tachycardia, and a drop in oxygen saturation. A sudden drop in oxygen saturation could be the only early clue) - CF often cough up blood-streaked sputum (hemoptysis) as a result of damage to blood vessels in the airway walls secondary to infections - Normal

Measles interventions? s/s?

- Highly contagious viral illness - through air - Interventions Vitamin A supplements Post Exposure prophylaxis (ie, MMR vaccine) for eligible, susceptible (eg, unvaccinated) family members within 72 hours of exposure Negative-pressure isolation room N95 respirator - s/s - conjunctivitis, koplik spots, coryza (copious clear mucus), coughing, erythmatous morbilliform rash - (Mumps, not measles, causes inflammation and tenderness of the parotid glands (ie, parotitis))

Potassium Chloride How to administer IV? Side effects?

- IV peripheral - not exceed 10 mEq/hr - Given via infusion pump; Thus never give through gravity infusion - Should be diluted and never in concentrated amount - Too rapid can cause cardiac arrest - IV central - not exceed 40 mEq/hr

Atrial fibrilation unresponsive to drugs

- If a client is in AF for more than 48 hours, anticoagulation therapy is needed for 3-4 weeks before cardioversion. - Anticoagulation therapy is necessary as cardioversion may dislodge an atrial thrombus, putting the client at risk for a stroke or other sequelae of thromboembolism - If 4 weeks of anticoagulation is not an option, TEE(Transesophageal echocardiogram) must be performed prior to cardioversion.

Postpartum hemorrhage due to uterine atony Interventions?

- If excessive bleeding persists after initial interventions (eg, firm fundal massage, oxytocin bolus), second-line uterotonic drugs (eg, carboprost, methylergonovine, misoprostol) may be given. - Methylergonovine [Methergine] is contraindicated for clients with high blood pressure (eg, preeclampsia, preexisting hypertension) because the primary mechanism of action is vasoconstriction. If administered to a hypertensive client, it can lead to further blood pressure elevation, seizure, or stroke

Coronary artery bypass Common complications?

- Improves blood flow to the heart. - Atelectasis is a common complication after heart surgery - It is collapse of lung tissue with loss of volume. Patients may have dyspnea or respiratory failure if atelectasis is extensive. They may also develop pneumonia - Encourage coughing, deep breathing, and use of the incentive spirometer

Cardiac catheterizatoin What to look for after procedure

- In first hour assess q15 min - ny report of back or flank pain should be assessed for possible retroperitoneal bleeding as back pain, tachycardia, and hypotension may be the only indication of internal bleeding. -

Chronic venous insufficiency - what can happen

- Inadequate venous blood return - Inhibits arterial blood flow to the area, resulting in inadequate supply of oxygen and nutrients to area cells and the development of stasis ulcers, which are typically found around the medial side of the ankle

Pregnancy Changes in physical state

- Increase in 40-45% in total blood volume (Hemodilution occurs - lower HGB and HCT) - High WBC count is normal, up to 15000 -Hypercoagulable state to prevent hemorrhage after birth - Increases risk for DVT and PE s/s of PE PE - anxiety/restlessness, pleuritic chest pain/tightness, shortness of breath, tachycardia, hypoxemia, and hemoptysis

nephrotic syndrome - at risk for

- Increased permeability of the glomerulus to proteins - Edema - Loss of immunoglobulins - susceptible to infection

Digoxin Cautions?

- Indications - Heart failure. Atrial fibrillation and atrial flutter (slows ventricular rate). Paroxysmal atrial tachycardia - Increased cardiac output (positive inotropic effect) and slowing of the heart rate (negative chronotropic effect) - <60 hold - Cardiac arrhythmias are the most dangerous symptoms (dizziness or lightheadedness) - Visual - (Alteration in color perception and visual changes) - Gastrointestinal - nausea and vomiting - Neurologic - confusion, lethargy - Monitor potassium - hypokalemia can cause digoxin toxicity

electroconvulsive therapy (ECT) - function? - Preperation? - common side effects? - caution and warnings afterwards? - Which medication should be discontinued?

- Induces a generalized seizure - For severe depression, acute mania, and certain schizophrenic syndromes - Anesthesia and a muscle relaxant will be administered; clients are unconscious and feel no pain during the procedure. - NPO status is required for 6-8 hours prior to treatment except for sips of water with medication - Driving is not permitted - Temporary memory loss and confusion in the immediate recovery period are common side effects of ECT - Any prescribed anticonvulsants should be discontinued prior to ECT.

Cardiac arrest in children

- Infants and children (age 1 year to puberty) often develop respiratory distress and bradycardia prior to cardiac arrest. - the nurse should contact emergency services and initiate rescue breathing. - After two minutes of rescue breathing, if the pulse remains ≤60/min and there are signs of poor perfusion (eg, skin pallor), the nurse should initiate compressions

Acute pyelonephritis s/s?

- Infection of the kidney - s/s - chills and fever, vomiting, flank pain, and costovertebral tenderness

Infective endocarditis watch out for

- Infective endocarditis is an infection in the heart valves or endocardium. - the vegetations over the valves can break off and embolize to various organs, resulting in life-threatening complications - These include: Stroke - paralysis on one side Spinal cord ischemia - paralysis of both legs Ischemia to the extremities - pain, pallor, and cold foot or arm Intestinal infarction - abdominal pain Splenic infarction - left upper-quadrant pain

Acute appendicitis s/s priority intervention Major complicaiton??

- Inflammation of the appendix - Onset pain at umbilicus / lower quadrant pain - Avoid interventions that increase intestinal blood circulation, gut motility, or appendiceal intraluminal pressure (warm compresses etc.) - Priority intervention - Fluid resuscitation - Sudden relieve of pain - rupture -> peritonitis

Mastitis interventions?

- Inflammation of the breast usually with infection - Continue breastfeeding - Proper breast technique - Warm compresses and massage breasts -Use analgesics - acetaminophen, ibuprofen - Soft supportive bra

septic arthritis s/s? Septic hip?

- Inflammation of the joint caused by infection - Localized (eg, pain, limited range of motion) and systemic infection symptoms (eg, fever) - A septic hip is considered a surgical emergency. The hip joint is prone to develop avascular necrosis (eg, damage to the femoral head) from compromised blood supply due to infection or injury (eg, fracture). This can result in sequelae that are significant in both the short term (eg, sepsis, death) and long term (eg, joint destruction) - Fever

Acute pericarditis relieved by? medication? can lead to ?

- Inflammation of the membranous sac (pericardium) surrounding the exterior of the heart - Pain relieved by sitting up and leaning forward - Treatment includes a combination of nonsteroidal anti-inflammatory drugs (NSAIDS) or aspirin plus colchicine. - Lead to pericardial effusion: Cause an increase in the amount of fluid in the pericardium (ie, pericardial effusion. More fluid - impairs the heart's ability to contract and eject blood. This complication (ie, cardiac tamponade) is life-threatening s/s of pericardial effusion - muffled or distant heart tones, hypotension, jugular venous distension, narrowed pulse pressure, pulses paradoxus

Acute pancreatitis Interventions? What serious complication?

- Inflammation of the pancreas - NPO status - nasogastric tube suction enzyme - Pain management - IV fluids - Can develop respiratory complications including pleural effusions, atelectasis, and acute respiratory distress syndrome (ARDS)

Prostatitis what is it? intervention?

- Inflammation of the prostate caused by infection - Interventions Avoid diuretics Engage in sex and masturbation Stool softeners - avoid straining Sitz baths help

Cauda equina syndrome s/s treatment

- Injury to the lumbosacral nerve roots (L4-L5) causing motor and sensory deficits. - S/S-severe lower back pain, inability to walk, saddle anesthesia (ie, motor weakness/loss of sensation to inner thighs and buttocks), and bowel and bladder incontinence (late sign) - Medical emergency - Reduction of pressure on the spinal nerves to prevent permanent damage

Parkinson disease What is it? Treatment?

- Progressive neurological disorder characterized by bradykinesia (loss of autonomic movements), rigidity, and tremors - Anticholinergic medications (eg, benztropine, trihexyphenidyl) are commonly used to treat tremor - precipitate urinary retention and an acute glaucoma

hypertrophic pyloric stenosis s/s assess what? what can we palpate

- Projectile vomiting after feeding is a classic manifestation Followed by hunger "hungry vomitter" - Emesis is nonbilious - Assess feeding technique and amount - A palpable, epigastric, olive-shaped mass

Child developing hip dysplasia interventions

- Proper swaddling technique - infants should be swaddled with their hips bent up (flexion) and out (abduction), allowing room for hip movement - Choosing infant carriers or car seats with wide bases - infant seats should allow for proper hip positioning in an abducted manner - Avoiding any positioning device, seat, or carrier that causes hip extension with the knees straight and together

Complications of oligohydramnios

- Pulmonary hypoplasia - due to the lack of normal alveolar distension by aspirated amniotic fluid - Umbilical cord compression - continuous fetal monitoring should be applied to monitor for variable decelerations

Ventricular tachycardia treatment?

- Pulseless or have a pulse - Unstable with a pulse - synchronized cardioversion - also for afib and rapid ventricular response - If pulseless - turn off cardioversion and defibrillator and do CPR instead - Stable with pulse - antiarrhythmic medications (Amiodarone)

Flank pain types

- Pyelonephritis (inflammation of the kidney parenchyma) causes flank pain that is experienced in the back at the costovertebral angle (the angle between the lower ribs and adjacent vertebrae) and may spread toward the umbilicus. -

Delirium tremens s/s? treatment?

- Rapid onset of confusion usually caused by withdrawal from alcohol - Physical effects may include shaking, shivering, irregular heart rate, and sweating(Sympathetic) - Delirium tremens and other withdrawal symptoms can be prevented with benzodiazepine administration during hospitalization.

Nonstress test

- Reactive Nonstress Test (Normal, Negative) ("Reactive" indicates a healthy fetus.) - Nonreactive Nonstress Test (Abnormal) - Unsatisfactory - The result cannot be interpreted because of the poor quality of the FHR tracing.

Seizure interventions

- Remain at client's bedside -Call for help Pad the side rails -Turn client on the side -Loosen clothing -Suction after seizure to maintain patent airway -Don't insert anything, teeth can be clenched

Urinary catheter

- Remove kink - Dislodge a visible obstruction by milking the tubing

Cast care interventions

- Report foul odors or hot areas (hot spots) in the cast, which may indicate infection - Avoid getting the cast wet, which may damage the cast and cause skin irritation/infection - Elevate the affected extremity above heart level for the first 48 hours to reduce edema - Regularly perform isometric and range of motion exercises to prevent muscle atrophy

exogenous surfactant to a premature infant

- Respiratory distress syndrome is a serious lung disorder caused by immaturity and the inability to produce surfactant, resulting in hypoxia and acidosis - administered by the intratracheal route

Wernicke encephalopathy s/s antidote?

- Results from alcohol - Altered mental status, oculomotor dysfunction, and ataxia - Give Thiamine "Antidote" for alcohol

Synchronized cardioversion

- Rhythms that are ideal for synchronized cardioversion are supraventricular tachycardia, ventricular tachycardia with a pulse, and atrial fibrillation with rapid ventricular response. - Not used for Vfib - If the defibrillator is not synchronized with the R wave in a client with a pulse, the shock may be delivered on the T wave and can cause a lethal arrhythmia (eg, Vfib).

Hypothermia risk for?

- Risk for dysrhythmias - Anticipate defibrillation - Frostbite ( Do not massage; Elevate area; Analgesia for pain during rewarming 98.6-102.2 F (37-39 C)

A peripherally inserted central catheter (PICC) care

- Routine care includes sterile dressing changes every 48 hours with a gauze dressing or 7 days with a transparent semipermeable dressing - All infusing medications (except vasopressors) must be paused before drawing blood from the PICC to prevent false interpretation of the client's serum levels

Amniotomy (artificial rupture of the membranes)

- Rupturing of the membranes allows the fetal head to contact the cervix more directly and may increase the efficiency of contractions. - The fetal heart rate needs to be monitored frequently, as there is an increased likelihood of a prolapsed cord with ruptured membranes and a high presenting part.

Diverticula ways to reduce risk? complication?

- Sac-like protrusions in the large intestine - Preventing constipation may help reduce the risk of diverticula forming and becoming inflamed - Acute diverticulitis - micro perforation of diverticula - Lower left abdominal pain with diarrhea/fever - Allow colon to rest - NPO, NG tube, IV antibiotics

Hepatic encephalopathy due to? s/s medication?

- Serious complication of end-stage liver disease (ESLD), due to inadequate detoxification of ammonia - Lethargy, confusion, and slurred speech; and Asterixis(a flapping tremor of the hands during arm extension) - Fetor hepaticus (ie, musty, sweet odor to the breath) - Medication- Lactulose( decreases serum ammonia) and rifaximin - Lactulose is a syrup like liquid that decreases intestinal ammonia absorption - Desired effect - 2-3 soft bowel movements each day - Don't stop suddenly, titrate it slowly - Can be mixed with water, juice, or milk (to improve flavor) or it can be administered via enema - can be given on an empty stomach for rapid results

Level of sedation

- Sleeping, easy to arouse - no action - Awake, alert - No action Slightly drowsy but easy to rouse - acceptable - Falls asleep during conversation - unacceptable, monitor respiratory status, notify health care provider to decrease sedation by 25-50 % Somnolent, minimal or no response to verbal and physical stimuli - Stop sedation, consider using naloxone, notify HCP, monitor respiratory status

Filgrastim(Neupogen) and pegfilgrastim (Neulasta)

- Stimulate neutrophil production - Prophylactic during chemotherapy prophylactically or during an infection

Glyburide For? Risk?

- Sulfonylureas - Under Beers Criteria - drugs dangerous for geriatric patients - Stimulate insulin release - Risk for prolonged hypoglycemia

Dysphagia

- Swallowing 2 times before taking another bite of food - Thickening liquids to assist swallowing - Avoiding over-the-counter cold medications. - Sitting upright for at least 30-40 minutes after meals. - Brushing teeth and using antiseptic mouthwash before and after meals - Smoking cessation

Rheumatoid arthritis (RA) What is it? What lab elevated?

- Symmetrical pain and swelling that initially affects the small joints of the hands and feet - Morning joint stiffness that lasts from 60 minutes to several hours - Elevated ESR and rheumatoid factor levels

Albuterol

- Sympathetic drug - Too much - palpitations, trempor, difficulty sleeping(insomnia)

Kawasaki disease s/s - expected finding? first line treatment? Discharge instruction?

- Systemic vasculitis (inflammation of arterial walls) - >5 days of fever; not contagious - s/s Irritability Joint pain and arthritis Desquamation (skin peeling) Hand and foot swelling Rash Cervical lymph node >1.5 cm Mucositis (inflammation of mucous membranes lining the digestive tract) Bilateral nonexudative conjunctivitis (pink eye) - First line treatment IV immunoglobulin(IVIG) and aspirin to prevent coronary artery aneurysm - Discharge teaching Should be monitored for HF due to IVIG Report fever to HCP - acute phase recurrence

Atrial septal defect s/s At risk for what?

- Systolic mumur - At risk for CHF and pulmonary hypertension - Increased respiratory exertion (eg, grunting) requires further assessment for CHF

PTT and PT

- T A normal prothrombin time is 11-16 secondshe therapeutic PTT target is 1.5-2.0 times the normal reference range of 25-35 seconds. A PTT value >100 seconds would be considered critical and could result in life-threatening side effects. - A normal platelet count is 150,000-400,000/mm3 (150-400 x 109/L). In a client with a history of liver cirrhosis, a platelet count of 80,000/mm3 (80 x 109/L) would be anticipated. An episode of bleeding rarely occurs with a platelet count >50,000 mm3 (50 x 109/L).

Vasectomy

- Take several months for the remaining sperm to be ejaculated - Alternative birth control should be used

Right sided stroke Characteristics of the person?

- Tend to be impulsive and unaware of deficits - Teach client's family to expect disinhibition and emotional outbursts

Puberty - boys - s/s in order

- Testicular enlargement, including scrotal changes, is the first manifestation of puberty and sexual maturation. - It is followed by the appearance of pubic, axillary, facial, and body hair.

Peripherally inserted central venous catheters (PICC) Care

- The central line dressing change is performed using sterile technique with the nurse wearing a mask to prevent contamination of the site with microorganisms or respiratory secretions - During injection cap and tubing changes, the client is instructed to hold the breath (or perform the Valsalva maneuver) to prevent air from entering the line, traveling to the heart, and forming an air embolism - During dressing, injection caps, and tubing changes, the client is placed in the supine position. If an air embolism is suspected, the client should be placed in the Trendelenburg position (head down) on the left side, causing any existing air to rise and become trapped in the right atrium

Informed consent

- The duration of action for hydrocodone is 4-6 hours; a client who received a dose 12 hours ago would no longer be impaired from the medication. - incomplete understanding of risk and would invalidate the signature

Hypertensive crisis

- The initial goal is usually to decrease the MAP by no more than 25% or to maintain MAP at 110-115 mm Hg - If the answer only has BP indicated, calculate MAP and see if it is more than 25%

DKA Initial intervention

- The initial hydrating solution is 0.9% saline infusion - Insulin therapy should be started after the initial rehydration bolus as serum glucose levels fall rapidly after volume expansion. - Peaked T waves indicate hyperkalemia in this client. Clients with insulin deficiency frequently have increased serum potassium levels due to the extracellular shift despite having total body potassium deficit from urinary losses. Once insulin is given, serum potassium levels drop rapidly, often requiring potassium replacement.

Liver normal x abnormal finding when palpating the liver

- The normal finding is a soft, distinct liver edge that is even with the bottom of the right rib cage or right costal margin - An abnormal finding would be a boggy liver edge below the rib cage (hepatomegaly).

TPN, what to do before a new bag arrives

- The nurse should hang 10% dextrose in water at the same infusion rate of 75 mL/hr until the new bag arrives. - If the 20% dextrose solution is temporarily replaced with an infusion lacking dextrose (eg, normal saline, lactated Ringer's [LR]), the pancreas will continue to produce insulin in response to the residual glucose, which may cause hypoglycemia

Developmental dysplasia of the hip (DDH)

- The presence of extra inguinal or thigh folds - Laxity of the hip joint on the affected side. Hip laxity/instability is tested through the Barlow and Ortolani maneuvers - Limited hip abduction occurs as contractures develop - he affected leg may be shorter than the opposite leg - if not cured, notable limp, walking on the toes, and a positive Trendelenburg sign (pelvis tilts down on unaffected side when standing on the affected leg)

Foreign body aspiration

- The primary rescue intervention for adults and children over age 1 is abdominal thrusts, known as the Heimlich maneuver. - Back blows and chest thrusts are appropriate interventions for a choking infant under age 1. Older children require abdominal thrusts to clear an obstructed airway. - If the child is conscious and able to cough or make sounds, the nurse should ask the child to forcefully cough before intervening. These signs indicate a partial obstruction still allowing airflow, which may be cleared with strong coughing. However, any signs of respiratory distress (eg, stridor, inability to speak, weak cough, and cyanosis) require immediate intervention

Seizure Phases

- The prodromal phase is the period with warning signs that precede the seizure (before the aural phase) - The aural phase is the period before the seizure when the client may experience visual or other sensory changes. Not all clients experience or can recognize a prodromal or aural phase before the seizure. - The ictal phase is the period of active seizure activity. - During the postictal phase, the client may experience confusion while recovering from the seizure. The client may also experience a headache. Postictal confusion can help identify clients by differentiating seizures from syncope. In syncope, there will be only a brief loss of consciousness without prolonged post-event confusion.

Inguinal hernia intervention after surgery

- The protrusion of a small loop of bowel through a weak place in the lower abdominal wall or groin - The client is taught to avoid activities that increase intraabdominal pressure - Prevent mechanical bowel obstruction(constipation) - Emergency - surgical intervention

After above the knee amputation

- The residual limb should not be elevated, especially after 24 hours - Use figure eight compression bandage -

Necrotizing Enterocolitis (NEC) Which infant at risk? Interventions?

- The wall of the intestine is invaded by bacteria, which cause local infection and inflammation that can ultimately destroy the wall of the bowel (intestine). - Occurs in premature and newborn infants. - Interventions Abdominal girth daily - worsening intestinal gas-associated swelling NPO and receive nasogastric suction to decompress the stomach and intestines. Parenteral hydration and nutrition and IV antibiotics are given Supine and undiapered.

Interventions to prevent UTI in female

- Tight clothing and synthetic fabrics (eg, nylon, spandex, Lycra) should be avoided as they seal in moisture and promote bacterial growth. Cotton underwear is recommended as it absorbs moisture. - Don't use antibacterial soap - kills normal flora

Nitrazine pH test Which results indicate positive or negative results? What can cause false positive results?

- To detect leaking amniotic fluid, most often if premature rupture of membranes is suspected - A yellow, olive, or green color suggests that amniotic membranes are intact (acidic results ph: 5.0; 5.5; 6.0 respectively) - A bluish green/gra and deep blue color suggests probable rupture of membranes (more basic ph 6.5; 7.0; 7.5 respectively) - Presence of blood or semen may result in a false positive, as serum and prostatic fluid are alkaline.

Clients after a mastectomy interventions?

- Trauma on operative side can lead to - lymphedema, thus No IV on that arm - Ensure documentation - Place a restricted extremity armband - Place a sign above client's bed - mastectomy precaution

Isoniazid (INH) For? Precautions?

- Treat TB - Interferes with B6 absorption - resulting in Peripheral neuropathy (numbness, tingling of extremities) Take pyridoxine (vitamin B6) if prescribed to prevent neuropathy - Hepatotoxicity ( jaundice, vomiting, dark urine, fatigue) - Avoid aluminum-containing antacids

Desmopressin For? Risk for?

- Treat central diabetes insipidus - Mimics the effects of naturally occurring ADH, which increases renal water resorption and concentrates urine - Risk for water intoxication from decreased urine output. - Watch out for s/s of water intoxication/hyponatremia (eg, headache, mental status changes, weakness)

Sumatriptan For? Contraindication?

- Treat migraine by constricting cranial blood vessels - Contraindicated with hx coronary artery disease and uncontrolled hypertension

Hyperkalemia - treatment?

- Treatment for hyperkalemia associated dysrhythmias is Calcium Gluconate - Once stabilized do (intravenous regular insulin with dextrose, sodium polystyrene sulfonate(Kayexalate), hemodialysis) to decrease Potassium

Retinoblastoma s/s common

- Tumor arising from a developing retinal cell - Missing red glow in eye - have white glow - Strabismus 2nd most common sign

Otitis media what ages typically? what increases risk?

- Typically <2 years - Higher risk with pacifier, drinking bottle while lying down, tobacco - Bulging and erythematous tympanic membrane, blocked eustachian tube

Neuroleptic malignant syndrome (NMS) s/s

- Uncommon adverse reaction to antipsychotic medications - Generalized muscle rigidity - high fever, muscular rigidity, altered mental status, and autonomic dysfunction

Autonomic dysreflexia(autonomic hyperreflexia) - who at risk? - s/s? - common cause

- Uncompensated sympathetic nervous system stimulation - Clients with T6 and above injury are at risk for this - life threatening - s/s- Hypertension Throbbing Headache Diaphoresis Bradycardia Piloerection (goosebumps) Flushing and nausea - common cause - Bladder irritation due to distention - catheterize Bowel impaction - rectal examination Constrictive clothing

Tumor lysis syndrome what damage can it cause?

- Uric acid can cause renal injury

Tracheostomy tube with inflated cuff When is it used?

- Used in clients with risk for aspiration - For alert and oriented and able to tolerate oral intake - deflate cuff to prevent aspiration

Benztropine For?

- Used to treat some extrapyramidal symptoms, which are side effects of some antipsychotic medications - Pseudoparkinsonism: Symptoms that resemble parkinsonism (eg, masklike face, shuffling gait, rigidity, resting tremor, psychomotor retardation [bradykinesia]) - Dystonia: Abnormal muscle movements of the face, neck, and trunk caused by sustained muscular contractions (eg, torticollis, oculogyric crisis, opisthotonos)

Intrapartum fetal heart rate monitoring Variable Early Accelerations Late deceleratoins

- VEAL CHOP - V - Cord compression/prolapse, oligohydramnios - E - Head compression - A - Okay (normal fetal oxygenation) - L - Placental insufficiency

Client on nasal cannula and a portable oxygen tank Interventions and things to avoid

- Vaseline is an oil-based, flammable product and should be avoided - Higher rates usually do not help and can even be dangerous in clients with COPD as they can decrease the drive to breathe. The client should notify the care provider about excessive shortness of breath as additional treatment may be indicated - Nail polish remover and nail polish contain acetone, which is highly combustible - Avoid synthetic and wool fabrics because they can cause static electricity

Atrial fibrillation intervention?

- Ventricular rate control is priority - lower HR - Calcium channel blockers (ie, diltiazem), beta blockers (ie, metoprolol), and digoxin. - Anticoagulants are long-term preventions

CABG care of leg and chest incisions

- Wash incisions daily with soap and water in the shower. Gently pat dry - Itching, tingling, and numbness around the incisions may be present for several weeks due to damage to the local nerves - Tub baths should be avoided due to risk of introducing infection - Do not apply powders or lotions on incisions as these trap the bacteria at the incision - Report any redness, swelling, and increase in drainage or if the incision has opened - Wear a supportive elastic hose on the legs. Elevate legs when sitting to decrease swelling

Tonsillectomy watch out for? discharge teaching?

- Watch for - continuous swallowing or cough, and restlessness - Teaching Avoid coughing, blowing nose, clearing the throat Limit physical activity Milk products are discourages due to their coating effects Oral mouth rinses, gargling and vigorous tooth brushing is avoided

Imminent birth pain management

- When birth is imminent, a pudendal block provides the best pain relief with the least maternal/newborn side effects and could be administered quickly by the health care provide - It does not relieve contraction pain but does relieve perineal pressure when administered in the late second stage of labor - An epidural can be administered in the first or early second stage of labor

Baby Jaundice

- Within 24 hours of birth is pathologic which is bad - Also report no voiding within 24 hours

Status Epilepticus s/s? which client is great risk for this? intervention?

- a client has been seizing for 5 minutes or longer - Grunting and a dazed appearance are 2 common signs - A client with hydrocephalus (abnormal collection of cerebrospinal fluid in the head) and a ventriculoperitoneal (VP) shunt is at a higher risk for seizures - IV benzodiazepines (diazepam or lorazepam) are used acutely to control seizures - rectal diazepam is often prescribed when the IV form is unavailable or problematic

Progestin only pills

- a form of oral contraception, work by thickening cervical mucus (ie, hinders sperm motility), thinning the endometrium (ie, hinders implantation), and preventing ovulation. - Cervical mucus changes last only approximately 24 hours, so the client must take the pill at the same time every day for it to be effective. If the pill is taken ≥3 hours late, a barrier method (eg, condom) is advised until the pill is taken correctly for 2 days - An additional POP should be taken if diarrhea or vomiting occurs within 3 hours of the last dose. - Unlike estrogen pills, these do not cause DVT

Risk for preterm labor

- a history of medical conditions, present and past obstetric problems, social and environmental factors, and substance abuse - a multifetal pregnancy - anemia - age younger than 18 years or first pregnancy at age older than 40 years.

Hypertensive crisis Risk for? Interventions?

- a life-threatening emergency due to the possibility of severe organ damage. - lower the blood pressure slowly, as too rapid a drop may cause decreased perfusion to the brain, heart, and kidneys - maintain MAP at 110-115 mm Hg.

Retinal detachment s/s ?

- a painless loss of vision "like a curtain" - light flashes, or a gnat/hairnet appearance

Arteriovenous fistula (AVF) Complication and it's s/s

- a permanent hemodialysis access - Arterial steal syndrome is an AVF complication that occurs when the anastomosed vein "steals" too much arterial blood, causing distal extremity ischemia - skin pallor, pain, numbness, tingling, diminished pulses, and poor capillary refill

Misoprostol

- a prostaglandin E1, is a cervical ripening agent - can stimulate frequent contractions. Therefore, administration of misoprostol is contraindicated if: the client is receiving another uterotonic simultaneously (eg, oxytocin) (Option 1). the client has a history of uterine surgery (eg, cesarean birth) due to an increased risk of uterine rupture at the surgical scar site (Option 2). the client has an abnormal fetal heart rate pattern or uterine tachysystole (ie, >5 contractions in 10 min) (Option 4).

Osteomyelitis

- a serious bone infection that requires long-term treatment with antibiotics.

Prevent aspiration pneumonia in a client with decreased level of consciousness

- a side lying or lateral position is used to decrease the risk for developing aspiration pneumonia. If vomiting were to occur, this position promotes drainage of emesis out of the mouth instead of down the pharynx where it can be aspirated into the lungs.

LPN

- administering routine medications for expected needs and performing focused assessments such as breath sounds, bowel sounds, and neurovascular checks (eg, pulse, capillary refill, numbness) - LPNs can also monitor findings such as flow rate and drainage in a client receiving continuous bladder irrigation - Continuous IV drug infusions are managed by the RN. This is especially true with drug categories such as anticoagulants, which will require titration depending on client response. -

Levetiracetam (Keppra)

- an anticonvulsant prescribed for seizure disorders - As with other antiseizure medications, levetiracetam has a depressing effect on the central nervous system (CNS), which may cause drowsiness, somnolence, and fatigue as clients adjust to the medication. Clients should be assured that this is common and typically improves within 4-6 weeks - may be enhanced if taken with other CNS-depressing substances (eg, alcohol) or medications. - New or increased agitation, anxiety, and/or depression or mood changes should be reported immediately as levetiracetam is associated with suicidal ideation

Testicular torsion

- an emergency condition in which blood flow to the testis (scrotum) has stopped - The testicle rotates and twists the spermatic cord, initially causing venous drainage obstruction that leads to swelling and severe pain. - testicular ischemia and necrosis, which require surgical removal of the testis - diagnosed with ultrasound. There is a short time frame in which testicular torsion can be treated (to untwist the rotation), generally 4-6 hours, making this condition a priority - it's higher than the normal one

Shoulder dystocia Interventions?

- an obstetrical emergency - Performing the McRoberts maneuver (ie, sharp flexion of maternal thighs toward abdomen to widen space between pubic bone and sacrum) and applying suprapubic pressure (ie, downward pressure applied to maternal pubic bone to dislodge fetal shoulder)

Metronidazole

- antibiotics - Don't do alcohol - Treat C. diff Severe C. diff infection - oral vancomycin - For Trichomonas infection (s a very common sexually transmitted disease (STD). It is caused by infection with a protozoan parasite called Trichomonas vaginalis)

Tetracycline interventions and cautions

- antibiotics - Tetracycline, doxycycline, minocycline - Take on an empty stomach -Avoid antacids or dairy products or iron supplements -Take with a full glass of water -Photosensitivity - severe sunburn can occur with tetracycline -Tetracycline and rifampin can decrease the effectiveness of oral contraceptives

Acute pancreatitis at risk for?

- are at risk for pancreatic abscess development. This mainly results from secondary infection of pancreatic pseudocysts or pancreatic necrosis. High fever, leukocytosis, and increasing abdominal pain may indicate abscess formation - health care provider should be notified immediately as antibiotic therapy and immediate surgical management

Braxton Hicks contractions

- are irregular, painless contractions that may occur intermittently throughout pregnancy - are normal in some pregnant women during pregnancy,

Elevated creatine kinase Due to? Interventions?

- are observed with severe muscle damage and can be a precursor to kidney injury - Forced saline diuresis with intravenous fluids (to prevent blockage of the renal tubules with myoglobin) is necessary to prevent permanent kidney damage. - Rhabdomyolysis occurs when muscle tissue is damaged and myoglobin (protein found in muscle tissue) is released into the blood - Acute kidney injury can occur when myoglobin overwhelms the kidneys' filtration ability. As myoglobin is excreted, the urine becomes very dark and is described as being a cola-brown colo

Hypertonic uterine contraction

- are painful, occur frequently, and are uncoordinated. - Relief of pain is the primary intervention to promote a normal labor pattern

Mediastinal chest tubes

- are used to drain air or fluid from the mediastinal space and/or pericardial cavity (ie, after cardiac surgery) - If chest tube drainage is markedly decreased, the nurse should quickly assess for signs of cardiac tamponade (Option 1) and if no such signs are present should troubleshoot other possible causes of chest tube occlusion

Cleft palate management

- at risk for aspiration and inadequate nutrition due to eating and feeding difficulties. This is due to the infant's inability to create suction and pull milk or formula from the nipple. - Hold the infant in an upright position - Tilt the bottle so that the nipple is always filled with formula. Point down and away from the cleft. - Use special bottles and nipples, including cross-cut and preemie nipples and assisted delivery bottles. Using a squeezable bottle allows the caregiver to apply pressure in rhythm with the infant's own sucking and swallowing - These infants swallow large amounts of air during feeding and so need to be burped more often to avoid stomach distension and regurgitation - Feeding slowly over 20-30 minutes reduces the risk of aspiration and promotes adequate intake of formula - Feeding every 3-4 hours; more frequent feedings may be tiring for the infant and the mother. Some infants may need to be fed more frequently if they are not consuming adequate amounts of formula.

β-Thalassemia

- autosomal recessive disorder characterized by the reduced production of 1 of the globin chains in the synthesis of hemoglobin - primarily in individuals of Mediterranean descent - Long-term infusion of iron can lead to hemosiderosis (iron overload) - Exjade or deferoxamine may be prescribed to treat overload

Acute urinary retention treatment?

- best treated with rapid, complete bladder decompression - Rapid decompression can be associated with hematuria, hypotension, and postobstructive diuresis

Respiratory syncytial virus (RSV)

- bronchiolar swelling and excessive mucus production - Contact isolation is required, and droplet precautions are added if within 3 ft (0.91 m) of the client, depending on facility policy - Palivizumab (Synagis), a monoclonal antibody, is administered intramuscularly once monthly during the winter and spring to prevent RSV in children at high risk for contracting the infection

When 8-10 cm dilation

- called "transition" - A mixture of mucus and pink/dark brown blood ("bloody show") is common

Phenytoin Side Effects

- can cause gingival hyperplasia (overgrowth of the gum tissues or reddened gums that bleed easily), especially in high doses. Folic acid supplementation can also reduce this side effect. - The other major side effects of phenytoin use are an increase in body hair, rash, folic acid depletion, and decreased bone density (osteoporosis)

Spontaneous rupture of membranes what can it cause? intervention?

- can cause umbilical cord prolapse - Perform a sterile vaginal examination - If palpated, manually elevate the presenting fetal part, leave hand in place, and call for help

Allergy to Penicillin ((eg, amoxicillin, ampicillin)

- can possibly experience a cross-sensitivity reaction to cephalosporin antibiotics (eg, cefazolin, cephalexin, ceftriaxone), - In particular, the nurse must first assess the type of reaction the client had to amoxicillin. The nurse should then clarify the prescription with the health care provider (HCP) prior to administration. - If this client's reaction to amoxicillin was a rash or other mild reaction that was not life-threatening, the HCP may decide that cephalosporin can be safely administered. However, cephalosporins are contraindicated for a client with a history of anaphylactic reactions to penicillin, and a different antibiotic should be prescribed.

Acromegaly what can it cause in adults

- caused by an overproduction of growth hormone (GH) - In an adult, increased GH results in overgrowth of soft tissues of the face, hands, feet, and organs. Additional heart sounds (S3, S4) require further assessment for cardiac conditions (eg, heart failure)

COPD (emphysema and bronchitis) s/s emphysema

- characterized by alveolar wall destruction - Lung tissues lose elasticity (recoil) due to permanently enlarged, "floppy" alveoli. - hyperinflation of the lungs (air trapping), manifested by hyperresonance on percussion and prolonged expiration - Barell-shaped chest - Pursed lip breathing ("puffing"), accessory muscle use, and the tripod position (leaning forward with hands on the knees) are seen during exertion and as the disease progresses.

Epilepsy early sign?

- chronic brain disorder characterized by recurrent seizure activity - An aura is a sensory perception that occurs prior to a complex or generalized seizure

Fibromyalgia s/s? med?

- chronic condition with widespread aching and pain in the muscles and fibrous soft tissue - is a chronic, nonspecific pain disorder. Common sequelae include fatigue, sleep disturbances, emotional distress (eg, anxiety, depression), and even mild cognitive impairments (eg, forgetfulness, difficulty concentrating) - abnormal central nervous system pain transmission and processing - Multiple tender points - Duloxetine (Cymbalta) - Relieve chronic pain that interferes with normal sleep patterns in clients with FM -

Ulcerative colitis at risk for? - s/s, interventions

- chronic inflammation of the colon with presence of ulcers - At risk for developing toxic megacolon (severe inflammatory colon distension) - Fever, nausea, vomiting, pain, and abdominal distension - Close monitoring, nasogastric tube for decompression, IV fluids, and antibiotics. Emergency surgery may be required.

Heart failure life threatening condition?

- client with heart failure who is short of breath and coughing up pink frothy sputum has developed acute pulmonary edema (fluid filling the alveoli), a potentially life-threatening condition.

Black Cohosh what is it used for? What can it caused?

- commonly used for menopausal - Can cause liver toxicity

Anencephaly

- congenital deformity in which some or all of fetal brain is missing -

Bismuth subsalicylate (Pepto-Bismol)

- contains a salicylate (same class as aspirin) and could possibly cause Reye syndrome in children - Reye syndrome can develop in children with a recent viral illness such as varicella or influenza. It can cause acute encephalopathy and hepatic dysfunction. Children with viral infections should not be given aspirin or products containing salicylates.

Sulfasalazine (Azulfidine)

- contains sulfapyridine and aspirin (5-ASA) - used as a topical gastrointestinal anti-inflammatory and immunomodulatory agent in inflammatory bowel disease (IBD) - Dehydration is a risk with IBD as the client can have up to 20 diarrheal stools a day. The client usually does not feel thirsty until after there is a fluid volume deficit. Sulfa can crystallize in the kidney if the client is dehydrated. - Normal urine specific gravity is 1.003-1.030. Elevated specific gravity can indicate concentrated urine and be a sign of dehydration

Arterial catheter placement?

- continuous BP monitoring - phlebostatic axis - fourth intercostal space at midaxillary line - the zero reference stopcock of the transducer is "leveled," or aligned with the level of the atrium, using a ruler or carpenter's level. If the zeroing stopcock is placed below this level, falsely high readings occur; if it is too high, falsely low readings are obtained

Patient controlled analgesia (PCA) - NS ?

- continuous IV solution (eg, normal saline) is required to keep the vein open and flush the PCA medication through the line so that the boluses reach the client - Clarify order if HCP orders discontinuation of NS

Fetal alcohol syndrome

- craniofacial abnormalities, intrauterine growth restriction, cardiac abnormalities, abnormal palmar creases, and respiratory distress. - These newborns may exhibit hyperirritability, vomiting, diarrhea, or an uncoordinated sucking and swallowing ability

Strabismus intervention?

- crossed eyes - Patch the stronger eye

In the event of a disaster involving the release of hazardous substances (eg, bioterrorism, chemical warfare agents)

- decontamination is vital to limit injury to the client and prevent exposure to other clients and staff - Disaster triage areas typically include a decontamination area (eg, showering station, cleansing station) that should be used to eliminate any residual hazardous materials and debris from the client. - the nurse should remove any clothing or personal effects and discard them appropriately to further eliminate sources of hazardous material.

Insulin needs in the first trimester

- decrease because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin

Volkmann contracture

- deformity of hand, finger, and wrist - Results from compartment syndrome associated with distal humerus fractures - Swelling - restrict arterial blood flow - Leads to tissue damage, wrist contractures, and an inability to extend the fingers - Medical emergency

Antisocial personality disorder intervention?

- disregard the rules, have a history of irresponsible behavior, and blame others for their behavior - Nursing interventions include setting firm limits

Digoxin toxicity

- dizziness or lightheadedness - brady - Visual symptoms (eg, alterations in color vision, scotomas, blindness) (Option 1) Gastrointestinal symptoms (eg, anorexia, nausea, vomiting, abdominal pain) - frequently the earliest symptoms (Option 3) Neurologic manifestations (eg, lethargy, fatigue, weakness, confusion)

Colostomy bag Care

- drink enough fluids - empty and 1/3 full - eliminate foods that produce gas - irrigation only needed at descending or sigmoid colostomies as the stool is more formed

Adenosine

- drug of choice for PSVT treatment - Treatment includes vagal maneuvers such as Valsalva, coughing, and carotid massage for PSVT - If vagal maneuvers and drug therapy are unsuccessful, synchronized cardioversion may be used.

Chronic kidney disease

- due to decrease of GFR -> less filtration - increased levels of K and PO4 - decrease of activation of vit D -> decrease gut absorption of calcium -> decrease serum calcium -> increase PTH release -> removal of calcium from bone(bone disease)

Pacemaker infection

- easily travel down the pacemaker lead wires into the heart, causing myocarditis and/or endocarditis - may disrupt pacemaker function and result in failure to sense or pace that causes decreased cardiac output and life-threatening arrhythmias - Signs and symptoms of pacemaker malfunction (eg, hypotension, bradycardia, dizziness)

Monoamine oxidase inhibitor(MAOI) For? Precautions?

- eg, phenelzine, isocarboxazid, tranylcypromine, selegiline) - Avoid foods containing high levels of tyramine - aged cheeses, sauerkraut, cured meats, draft beer and fermented soy products (for example, soy sauce, miso and tofu) - Can cause dangerously high blood pressure. - Interactions - These include other antidepressants, certain pain or headache medications, and the herbal supplement St. John's wort - Wait two or more weeks before taking other antidepressants

Sulfa drugs Cautions?

- eg. Trimethoprim- sulfamethoxazole(Bactrim; erythromycin-sulfisoxazole (Eryzole, Pediazole) - - Crystalluria causing kidney injury - client should drink 8 glasses of water - Photosensitivity and risk for sunburn - Causes folic acid deficiency - Rarely life-threatening agranulocytosis (leukopenia) - Used for mild to moderate chronic inflammatory rheumatoid arthritis (RA) and inflammatory bowel disease (eg, ulcerative colitis) - https://www.mayoclinic.org/diseases-conditions/drug-allergy/expert-answers/sulfa-allergy/faq-20057970

inflammatory breast cancer s/s

- enlarged lymph nodes - edema, erythema, Peau d'orange of breast - retracted nipples - breast lymph channels are blocked by cancer cells, creating breast tissue that becomes red, warm, and has an orange peel (peau d'orange), pitting appearance on the skin surface - Tiny indented areas all over the breast

Late decelerations interventions?

- fetal oxygenation is compromised - Stop oxytocin Reposition Oxygen by mask IV bolus

Central venous catheter occlusion

- first thing is to reposition - assess for clamps, kinks, and precipitate - afterwards attempt to flush the device - if still occluded contact HCP

Bruising behind the ear

- following head trauma may indicate a basilar skull fracture - risk of serious intracranial injury, which is the most common cause of traumatic death in children

Balloon tamponade tube intervention during respiratory distress?

- for bleeding esophagel varices - If respiratory distress occurs - cut the tube with scissors

polycythemia vera risk for? intervention?

- general increase in red blood cells (erythremia) -Risk of developing blood clots - Rlevate the legs and feet when sitting, wear support stockings, and report signs of thrombosis (eg, swelling and tenderness in the legs) - Adequate fluid intake during exercise and hot weather is important to reduce fluid loss and decrease viscosity - Clients with PV need periodic phlebotomy to remove excess blood - Hematorcrit > 65% - Hemoglobin >22 g/L

Reduce allergens interventions

- high-efficiency particulate air (HEPA) air-conditioner filters - Keeping windows closed and staying indoors, particularly during times of heavy pollen - Applying hypoallergenic pillow and mattress covers to prevent exposure to dust mites - Reducing or removing carpet and area rugs - Vacuuming carpet at least once a week with a HEPA filter vacuum - Mopping hard floors and damp-dusting furniture at least once a week

Impetigo s/s

- highly contagious skin infection, mainly in children - honey-colored crusts - No longer infectious after 24 h of antibiotics

Thiazide diuretics

- hydrochlorothiazide, chlorthalidone - Hypokalemia -> muscle cramps, weakness, paresthesia

ectopic pregnancy s/s

- implantation of the fertilized egg in any site other than the normal uterine location - abdominal pain with referred shoulder pain - hypotension (dizziness, tachycardia)

Opioid agonist-antagonist

- include butorphanol tartrate (Stadol) and nalbuphine hydrochloride (Nubain) - crosses the placental barrier, peaking in 30-60 minutes; its duration of action is approximately 2-4 hours. If given near the time of birth, there is a risk for newborn respiratory depression, which may require naloxone (Narcan) to reverse the effects -

Magnesium toxicity

- include respiratory depression, loss of deep tendon reflexes, and a sudden decline in fetal heart rate and maternal heart rate and blood pressure. - Therapeutic serum levels of magnesium are 4 to 7.5 mEq/L

Hyperthyroidism diet

- increased metabolic rate - Adherence to a high calorie diet (4000-5000 calories per day). - Avoidance of high-fiber foods due to the constant hyperstimulation of the gastrointestinal (GI) tract. High-fiber foods may increase GI symptoms (eg, diarrhea) Consumption of approximately 6 full meals and snacks per day. These should be packed with protein (1-2 g/kg of ideal body weight), carbohydrates, and be full of vitamins and minerals - However, high-fiber diets are recommended if the client with hyperthyroidism has constipation - Avoidance of stimulating substances (eg, caffeinated drinks: coffee, tea, soft drinks). - Avoidance of spicy foods as these can also increase GI stimulation.

Metformin most common side effect

- increases the sensitivity of insulin receptors in cells and reduces glucose production by the liver. - These actions increase the efficacy of insulin present in the body and prevent large rises in blood glucose after meals - Because metformin does not stimulate insulin secretion by the pancreas, the risk of hypoglycemia is minimal -most common side effect of metformin is gastrointestinal disturbances, including decreased appetite, nausea, and diarrhea

Acute cholecystitis intervention s/s causes

- inflammation of gallbladder - Maintain NPO, NG tube low suctioning, Semi-Fowler - Severe pain in the right upper quadrant with radiation to the right shoulder and vomiting Fatty food cause

fetal scalp electrode (FSE)

- internally applied, electronic monitoring device used to closely evaluate fetal heart rate (FHR). - Indications for FSE placement may include high-risk maternal conditions (eg, obesity, diabetes, hypertension) and/or nonreassuring FHR patterns (eg, late decelerations, minimal variability). - sharp electrode directly into the fetal scalp or presenting part (ie, buttocks if breech) - Avoided in the presence of bloodborne infections (eg, hepatitis B, HIV) because the risk of fetal infection is increased by the small puncture - It is helpful if the fetal presenting part is engaged (ie, 0, +1, or +2 station) to facilitate proper placemen -

Tardive dyskinesia s/s causative agent?

- involuntary movements of the facial muscles, tongue, and limbs(sucking/smacking lip motions); a possible neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine receptors - Ex. metoclopramide

Multiple Sclerosis

- is a chronic, relapsing, and remitting degenerative disorder involving the brain, optic nerve, and spinal cord. - Optic neuritis is a common presentation but is not life-threatening

Osteoarthritis (OA)

- is a degenerative disorder of the synovial joints (eg, knee, hip, fingers) that causes progressive erosion of the articular (joint) cartilage and bone beneath the cartilage - Pain exacerbated by weight-bearing activities - Crepitus, a grating noise or sensation with movement that can be heard or palpated - Morning stiffness that subsides within 30 minutes of arising - Decreased joint mobility and range of motion - Atrophy of the muscles that support the joint - Low-grade fever develops as part of systemic inflammation. OA is typically a noninflammatory, nonsystemic disorder. - Serum rheumatoid factor is positive in clients with systemic rheumatoid arthritis. No diagnostic laboratory tests or biomarkers exist for OA.

Inferior vena cava filter

- is a device that is inserted percutaneously, usually via the femoral vein. - The filter traps blood clots from lower extremity vessels (eg, embolus from deep venous thrombosis) and prevents them from migrating to the lungs and causing a pulmonary embolism (PE) - It is prescribed when clients have recurrent emboli or anticoagulation is contraindicated.

Wilms tumor (nephroblastoma)

- is a kidney tumor that usually occurs in children age <5. Most often it involves only one kidney, and the prognosis is good if the tumor has not metastasized. - the abdomen should not be palpated, as this can disrupt the encapsulated tumor. It is important to post the sign "DO NOT PALPATE ABDOMEN" at the bedside. It is also essential that the child be handled carefully during bathing

Bronchiolitis

- is a lower respiratory tract infection most commonly caused by respiratory syncytial virus. It causes inflammation and obstruction of the lower respiratory tract - can experience mild cold symptoms or respiratory distress. - The infant will have difficulty feeding and can become dehydrated. Medical care is supportive and includes suctioning, oxygen, and hydration.

Hodgkin's disease (a type of lymphoma

- is a malignancy of the lymph nodes. -painless, firm, and movable adenopathy in the cervical and supraclavicular areas and abdominal pain as a result of enlarged retroperitoneal nodes. Hepatosplenomegaly also is noted

Cystoscopy complications

- is a procedure that uses a flexible fiber-optic scope inserted through the urethra into the urinary bladder with the client in the lithotomy position. - Complications associated with cystoscopy include urinary retention, hemorrhage, and infection - clients are instructed to notify the health care provider (HCP) immediately if they have bright red blood when urinating, blood clots, inability to urinate, fever >100.4 F (38 C) and chills, or abdominal pain unrelieved by analgesia.

Dialysis disequilibrium syndrome (DDS)

- is a rare but potentially life-threatening complication that can occur in clients during the initial stages of hemodialysis (HD); it can be prevented by slowing the rate of dialysis - During HD, solutes (ie, urea) are removed more quickly from the blood than from the brain cells and cerebrospinal fluid, creating a concentration gradient that can lead to excess fluid in the brain cells and increased intracranial pressure. Characteristic neurologic manifestations include nausea and vomiting, headache, restlessness, change in mentation, and seizure activity. - If DDS is suspected, the health care provider should be contacted immediately - If severe, DDS can progress to coma and death. If DDS is identified during treatment, the rate of dialysis should be slowed or stopped. Treatment focuses on interventions to decrease cerebral edema and manage symptoms.

Buck traction

- is a type of skin traction used to immobilize hip fractures and reduce pain and spasm - assess neurovascular status (eg, pulse, capillary refill, color, temperature, sensation, movement) and skin integrity in the limb to which the boot is applied - traction boot is fitted properly and that the limb remains straight in a neutral position

Phenazopyridine hydrochloride (Pyridium) For?

- is a urinary analgesic prescribed to relieve the pain and burning associated with a urinary tract infection.

Duchenne muscular dystrophy?

- is an X-linked recessive (carried by females and affecting males) disorder that causes the progressive replacement of dystrophin, a protein needed for muscle stabilization, with connective tissue - In response to proximal muscle weakness, the calf muscles hypertrophy (pseudohypertrophy) initially and are later replaced by fat and connective tissue - aise themselves to a standing position using the classic Gower sign/maneuver (placing hands on the thighs to push up to stand) and walk on tiptoes - frequent tripping and falling

Rheumatic fever Most likely cause?

- is an acute inflammatory disease of the heart. - complication that occurs 2-3 weeks after a streptococcal pharyngitis. - RF is caused by a delayed-onset autoimmune reaction involving anti-streptococcal antibodies that cross-react with the antigens in the heart and other organs - RF affects the heart, skin, joints, and central nervous system. The presence of 2 major criteria or 1 major and 2 minor criteria and evidence of a preceding streptococcal infection indicate a high probability of RF. Major: Joints, carditis, nodules, erythema marginatum, syndenham chorea Minor: Fever, Arthralgias, Elevated erythrocyte sedimentation rate/C- reactive protein, Prolonged PR interval - Late sequelae - Mitral regurgutation/stenosis -Prevention - penicillin for group A streptococcal pharyngitis

Marfan syndrome s/s ? Contraindications?

- is an autosomal dominant disorder affecting the connective tissues of the body. Abnormalities are mainly seen in the cardiovascular, musculoskeletal, and ocular systems - Clients with Marfan syndrome are very tall and thin, with disproportionately long arms, legs, and fingers - Competitive or contact sports are discouraged - Pregnancy can cause death

Isotretinoin (Accutane, Amnesteem) for?

- is an oral acne medication derived from vitamin A. - Taking vitamin A supplements along with isotretinoin can cause vitamin A toxicity, - is prescribed for severe, disfiguring nodular acne that has been unresponsive to other therapies (eg, antibiotics) - It works by decreasing sebum secretion and shrinking sebaceous glands (often permanently); one course of isotretinoin is typically very effective - is a teratogenic medication known to cause serious harm to a fetus if taken during pregnancy. - Females prescribed isotretinoin must participate in a risk management program. Requirements generally include two negative pregnancy tests before initiating isotretinoin and two forms of contraception((ie, use 1 month prior to starting isotretinoin, during treatment, and for 1 month after discontinuing isotretinoin) - Refills can be only obtained after a negative pregnancy test (performed monthly during therapy). Blood donation is also discouraged for both males and females during therapy.

Scleroderma

- is an overproduction of collagen that causes tightening and hardening of the skin and connective tissue. This is a progressive disease without a cure, and treatment is aimed at managing complications - enal crisis is a life-threatening complication that causes malignant hypertension due to narrowing of the vessels that provide blood to the kidneys. - Raynaud phenomenon can develop secondary to scleroderma - Pulmonary fibrosis is a progressive complication of scleroderma that is defined as scarring of lung tissue, which then causes reduced function, dry cough, and dyspnea. - Heartburn and dysphagia (difficulty swallowing) are common symptoms associated with scleroderma

Cellulitis interventions

- is inflammation of the subcutaneous tissues that is typically caused by bacterial infection (eg, Staphylococcus aureus, group A Streptococcus) resulting from an insect bite, cut, abrasion, or open wound. Cellulitis is characterized by redness, edema, pain, and fever. - the affected extremity is elevated when the client is sitting or lying down to promote lymphatic drainage. Flat or dependent positioning may worsen edema, which delays recovery and contributes to pain - Applying warm compresses promotes circulation to the area of infection, alleviates discomfort, and helps reduce edema.

Backup contraception

- is required for 7 days after starting oral contraceptive - unless the pill pack is started on the first day of menses

Levothyroxine

- is the first-line medication for treatment of hypothyroidism during pregnancy. The client may experience some relief of symptoms beginning approximately 3-4 weeks after initiating levothyroxine therapy - Hormone levels are usually rechecked every 4-6 weeks until normal thyroid hormone levels are achieved. It may take up to 8 weeks after initiation to see the full therapeutic effect. - iron can affect the absorption of levothyroxine and decrease its effectiveness. The nurse should instruct the client to take levothyroxine in the morning on an empty stomach, at least 4 hours before or after taking a prenatal vitamin

Neurologic injury interventions

- is the most common cause of mortality in clients who have had cardiac arrest, particularly ventricular fibrillation or pulseless ventricular tachycardia - Inducing therapeutic hypothermia in these clients within 6 hours of arrest and maintaining it for 24 hours has been shown to decrease mortality rates and improve neurologic outcomes. It is indicated in all clients who are comatose or do not follow commands after resuscitation.

Eclampsia

- is the onset of convulsions or seizures that cannot be attributed to other causes in a woman with preeclampsia. - Delivery is the only cure for preeclampsia-eclampsia syndrome. - Magnesium sulfate is a central nervous system depressant used to prevent/control seizure activity in preeclampsia/eclampsia client - A therapeutic magnesium level of 4-7 mEq/L (2.0-3.5 mmol/L) is necessary to prevent seizures in a preeclamptic client.

Cyclosporine For?

- is used to prevent organ rejection in people who have received a liver, kidney, or heart transplant. - Gingival hyperplasia (ie, swollen, bleeding gums) is common

Orlistat

- lipase inhibitor that prevents the breakdown and absorption of fats from the intestine - prescribed to clients with obesity who have difficulty losing weight or a comorbidity that makes weight loss therapeutically essential (eg, diabetes, heart disease - also interferes with fat-soluble vitamin uptake. Clients should offset this effect by taking a multivitamin that contains vitamins A, D, E, and K. To be most effective, multivitamins should be taken >2 hours after taking orlistat

Borderline personality disorder

- live in fear of rejection and abandonment. To avoid abandonment, they use manipulation and control, often unconsciously, to prevent a person from leaving. - The manipulative behavior may be of a positive nature, such as the use of flattery, or a negative nature, such as distancing from the other person. - An individual with BPD may also engage in self harm or suicidal behaviors in an attempt to gain attention from the other person and keep that person from leaving. - have different nurse take care every time to prevent depedency

Contraction stress test

- may be interpreted as negative (normal), positive (abnormal), or equivocal. -

Postpartum hemorrhage (PPH) type?

- may be primary (ie, <24 hours since birth) or secondary/delayed (ie, >24 hours) - If bleeding bright red after 3-4 days, concerning

IV furosemide

- may cause ototoxicity, particularly when high doses are administered in clients with compromised renal function. -

Desmopresin

- mimics the effects of naturally occurring ADH, which increases renal water resorption and concentrates urine. - n must have their fluid and electrolyte status closely monitored for symptoms of water intoxication/hyponatremia (eg, headache, mental status changes, weakness)

toxic epidermal necrolysis

- most commonly associated with a medication reaction, that results in widespread erythema, blistering, epidermal shedding, keratoconjunctivitis, and skin erosion (ie, denuded skin). It is a severe form of Stevens-Johnson syndrome - the major cause of death related to toxic epidermal necrolysis is sepsis

Rhabdomyolysis at risk for?

- muscle fibers are released into the blood, usually after an intense muscle injury from exercise, heat stroke, or physical trauma. - Acute renal failure occurs - Rapid IV fluid resuscitation

Poorly controlled maternal diabetes

- negatively affects fetal growth and oxygenation throughout pregnancy. - the fetus experiences hyperglycemia and produces excess insulin. - To compensate, the fetus increases metabolic activity and oxygen consumption. Fetal erythropoietin production subsequently increases to produce additional red blood cells (erythropoiesis), which are needed to transport oxygen to tissues. This increased production of red blood cells leads to polycythemia and increased circulatory viscosity (>65% hematocrit)

Myelomeningocele

- neural tube fails to fuse properly during fetal development - Outpouching of spine

Amyotrophic lateral sclerosis (ALS) s/s survival?

- neurodegenerative disease with no cure - fatigue, progressive muscle weakness, twitching and muscle spasms, difficulty swallowing, difficulty speaking, and respiratory failur - 3-5 years of survival

Bowel sounds

- normal bowel sounds are relatively high-pitched clicks or gurgles. - Loud gurgles (borborygmi) indicate hyperperistalsis and are commonly associated with nausea and vomiting. - A swishing or buzzing sound represents turbulent blood flow associated with a bruit. Bruits are not normal sounds - Bowel sounds are very high-pitched and loud (hyperresonance) when the intestines are under tension, such as in intestinal obstruction.

Blood products

- not be left at room temperature for >30 minutes before a transfusion - If the start of the transfusion is delayed, the blood should be returned to the blood bank, where it can be refrigerated at a precise temperature

Precipitous birth management

- occurs when labor lasts <3 hours from contraction onset until birth. Signs of imminent birth include involuntary pushing/bearing down with contractions, grunting, or report of sensations of having a bowel movement. - If a client arrives at the hospital in second-stage labor (ie, pushing), the nurse rapidly assesses whether birth is imminent by applying gloves and observing the perineum for bulging or crowning of the presenting fetal part - Women who have experienced precipitous labor often describe feelings of disbelief that their labor progressed so rapidly. To assist the client to process what has happened, the best option is to support the client in her reaction to the newborn infant (being passive with the baby)

Rubella vaccine

- ok to breastfeed - Subcutaneous road - the virus is shed in the urine and other body fluids.

STEMI

- one of the coronary arteries is completely occluded. - . Prompt treatment (eg, percutaneous coronary intervention, thrombolytics) is needed to restore myocardial oxygen supply and limit myocardial damage.

abruptio placentae

- premature separation of the placenta from the uterine wall - acute abdominal pain is present. Uterine tenderness - The abdomen feels hard and boardlike on palpation

Metabolic syndrom

- presence of 4 or more of the following criteria - Increased waist circumference: ≥40 in (102 cm) in men, ≥35 in (89 cm) in women (Option 2) Blood pressure: ≥130 mm Hg systolic or ≥85 mm Hg diastolic or drug treatment for hypertension (Option 3) Triglyceride level: >150 mg/dL (1.7 mmol/L) or drug treatment for elevated triglycerides (Option 5) High-density lipoprotein (HDL) levels: <40 mg/dL (1.04 mmol/L) in men and <50 mg/dL (1.3 mmol/L) in women or drug treatment for low HDL-C Fasting glucose levels: ≥100 mg/dL (5.6 mmol/L) or drug treatment for elevated blood glucose (Option 4)

Emergency contraception (EC)

- prevents pregnancy after unprotected intercourse - taken within 5 days of intercourse; however, efficacy is reduced after 3 days (72 hours) - The copper intrauterine device (IUD) may be inserted for up to 5 days after intercourse as another form of EC

Abdominal aneurysm

- pulsatile mass in the periumbilical area slightly to the left of the midline. A bruit may be auscultated over the site - Back/abdominal pain can be present due to compression of nearby anatomical sites or nerve compression from an expanding/rupturing abdominal aortic aneurysm (AAA)

Asystole and PEA intervention?

- pulseless electrical activity, heart muscle is not contracting despite an organized rhythm - Do CPR - Don't shock

Palifermin (Kepivance)

- recombinant human keratinocyte growth factor, prevents oral mucositis in clients diagnosed with hematologic malignancies - is the painful inflammation and ulceration of the mucous membranes lining the digestive tract, usually as an adverse effect of chemotherapy and radiotherapy treatment for cance

Hypophysectomy at risk for?

- removal of pituitary gland - At risk for developing neurogenic diabetes insipidus (DI), a metabolic disorder of low ADH levels - loss of circulating ADH results in massive diuresis of dilute urine

Cholecystectomy

- removal of the gallbladder Laparascopic - internally Open - basically open..

Chronic kidney disease risks? s/s which electrolyte will be elevated?

- risk for uncontrolled hypertension and hypertensive emergencies due to fluid retention - s/s Nausea, vomiting, and headache High potassium and phosphorus due to limited filtration Avoid dairy and certain fruits(bananas, oranges, coconuts, watermelons, and avocados) - high in potassium

Clomiphene (Clomid, Serophene)

- s a selective estrogen receptor modulator that is used as a first-line treatment for infertility for women and works by stimulating ovulation - orally for 5 days early in the menstrual cycle (eg, beginning on days 3-5 of menses). Ovulation typically occurs 5-9 days after completing the medication. Therefore, it is necessary for the client to understand the importance of engaging in frequent sexual intercourse (eg, every other day for 1 week) 5 days after completing the medication for the best chance of successful conception

Jaundice assess where

- sclera, nail beds, and mucous membranes - Generalized jaundice appears in the skin throughout the body.

Gastric pH

- should be acidic (pH ≤5). A pH ≥6 requires x-ray confirmation of tube placement.

Urine 24h

- start the collection in the morning after the client's first morning voiding and to end it at the same hour the next morning after the morning voiding

Naloxone

- start to wane at 20-40 minutes after administration, and its duration of action is approximately 90 minute - If used for respiratory depression due to opioids, be sure to check patient's respiratory status again in 1 hour because the opioid lasts longer than naloxone

Carbon monoxide

- stop the feeding for 1 to 2 hours before and after administering phenytoin as products containing calcium (eg, antacids, calcium supplements) and/or nutritional enteral tube feedings can decrease the absorption and the serum level of this drug - Carboxyhemoglobin level - treatment - high-flow 100% - often happens in fall and winter due to increased used of heat sources in an enclosed space

Steps to assess abdomen

- supine - inspect - auscultate - percussion - palpation is last

Tracheal deviation

- tension pneumothorax

Expressive aphasia,

- the inability to express spoken words, occurs after a transient ischemic attack or stroke. - This will occur if the frontal lobe (Broca aphasia, expressive) or temporal lobe (Wernicke aphasia, receptive) is injured.

Buerger's disease what does it cause? what other secondary disease develops? How to prevent?

- thromboangiitis obliterans -Thrombus formation, resulting in distal extremity ischemia - Causes intermittent claudication of the feet and hands - Many clients also develop secondary Raynaud phenomenon (cold sensitivity). - Raynaud During a typical episode, digital arteries (most often in the fingers) constrict and blood flow is impaired, causing the skin to turn pale and then blue and to feel numb and cold As blood flow returns to the affected digits, the skin turns red and a throbbing or tingling sensation is often felt. This is an expected finding; episodes usually resolve in 15-20 minutes once the trigger has been removed (eg, rewarming of the fingers) Cessation of all tobacco and marijuana use in any form.

A ventriculoperitoneal shunt Used for? Complications?

- treat hydrocephalus and is usually placed at age 3-4 months - Blockage and infection are complications (Increased ICP, Cushing's triad (bradycardia, hypertension, slowed respiration, widened pulse pressure)

Magnesium sulfate

- used to halt preterm labor contractions and is used for preeclamptic clients to prevent seizures - Adverse effects include flushing, depressed respirations, depressed deep tendon reflexes, hypotension, extreme muscle weakness, decreased urine output, pulmonary edema, and elevated serum magnesium levels.

Methylergonovine

- used to prevent or control postpartum hemorrhage by contracting the uterus - causes continuous uterine contractions and may elevate the blood pressure. A priority assessment before the administration of the medication is to check the blood pressure

Ulcerative colitis

- who has abdominal distension, bloody diarrhea, and fever likely has toxic megacolon. - This is a common, life-threatening complication of inflammatory bowel disease and is seen more frequently in ulcerative colitis than in Crohn disease

Nurse's role with written consent

- witness that the client signed - Agree that the patient was competent at the time of signing - document in the client's medical record that the informed consent was given

Metabolic syndrome what factors to look at?

- ≥3 metabolic health factors - Abdominal obesity: Waist circumference (≥40 inches [102 cm] in men, ≥35 inches [89 cm] in women) - High serum triglycerides >150 mg/dL (1.7 mmol/L) or hypertriglyceridemia drug treatment - Low levels of high-density lipoprotein (HDL) cholesterol (<40 mg/dL [1.0 mmol/L] in men, <50 mg/dL [1.3 mmol] in women) - Hypertension ≥130/85 mm Hg or hypertension drug treatment - Fasting blood glucose ≥100 mg/dL (5.6 mmol/L) or hyperglycemia drug treatment

Parvovirus B-19 s/s risk for

-"Fifth disease" -"Slapped cheek" rash -Can cause pregnancy anomalies if infected when pregnant(TORCH infection (Toxoplasmosis, Other [parvo-B19(Fifth disease)/varicella zoster(VZV)], Rubella, Cytomegalovirus, Herpes simplex virus)

Acute Glomerulonephritis (AGN) s/s commonly induced by ? monitor for?

-(inflammation of glomeruli due to autoimmune attack on the kidneys SYMPTOMS-proteinuria , hematuria , edema, renal failure is possible; TREATMENT-decrease BP, antibiotics and anti-inflammatory drugs) - Most commonly induced by prior group A beta-hemolytic streptococcal infection of the skin or throat - Periorbital and facial/generalized edema, hypertension, and oliguria - Severe hypertension is an anticipated complication - monitor

Thrombolytic therapy

-Aimed at stopping the infarction process -Dissolves thrombus that may lead to MI -Within 12 hours of symptom onset

Dicyclomine hydrochloride (Bentyl) Contraindication?

-Anticholinergic - Contraindicated for narrow angle glaucoma

Vulvar hematoma

-Application of ice reduces swelling caused by hematoma formation in the vulvar area - Because the client has had epidural anesthesia and is anesthetized, she cannot feel pain, pressure, or a tearing sensation. Changes in vital signs indicate hypovolemia in an anesthetized postpartum client with vulvar hematoma

CVC dislodgement leading to PE interventions

-Apply an occlusive dressing to the insertion site to prevent entry of additional air into the bloodstream -Administer 100% oxygen via non-rebreather mask to improve oxygenation -Position the client in left lateral Trendelenburg position to promote venous air pooling in the heart apex rather than the lung capillary beds -Continuously monitor vital signs and client respiratory effort to identify changes in client status -Notify the health care provider immediately

Furosemide Side effects?

-Can cause hypokalemia - Muscle cramps, weakness, or paresthesia - Lethal cardiac dysrhythmias and paralysis - All related to electrolytes - IV furosemide may cause ototoxicity, particularly when high doses are administered in clients with compromised renal function.

Warning signs of Cancer: CAUTION

-Change in bowel or bladder habits -A sore that does not heal -Unusual bleeding or discharge from a body orifice -Thickening or a lump in the breast or elsewhere -Indigestion or difficulty in swallowing -Obvious change in a wart or mole -Nagging cough or hoarseness -Unintentional weight loss of >10% of usual weight (in non-obese clients)

A halo external fixation device Interventions?

-Clean pin sites with sterile solution -Keep the vest liner clean and dry -Place foam inserts under pressure points -Small pillow under head -Wrench available at all times

Colonoscopy Preperation?

-Clear liquid diet the day before -Nothing by mouth 8-12 hours prior to the examination -The health care provider prescribes a bowel-cleansing agent such as a cathartic, enema, or polyethylene glycol (GoLYTELY) the day before the test. The type of prep depends on the health care provider's preference and client health status.

Menopause Changes to body?

-Decrease in estrogen -Increased risk for osteoporosis(Increase calcium) and coronary artery disease (monitor cholesterol levels) -Sleep disturbances, fat redistribution, and vaginal atrophy -Preposition to gain weight -Emotional problems due to hormonal change

Bishop score

-Determines maternal readiness for labor by evaluating whether the cervix is favorable by rating cervical dilation, effacement, consistency, position, and station - >8 indicate a successful induction

Morning sickness Interventions

-Eating several small meals during the day (ie, high in protein or carbohydrates and low in fat) -Drinking fluids (preferably clear, cold, carbonated beverages) between, rather than with, meals -Having a high-protein snack before bedtime and on awakening -Consuming foods/drinks with ginger (eg, ginger tea, ginger lollipops, ginger chews) -Consuming foods high in vitamin B6 (eg, nuts, seeds, legumes)

Abdominal aortic aneurysms s/s

-Ecchymosis -Increased abdominal girth -Tachycardia -Weak or absent peripheral pulses -Decrease HCT/HGB -Increased pain in the pelvis, back or groin -Decreased urinary output

Acute angle closure glaucoma s/s ?

-Emergency - can cause blindness due to increased IOP -Sudden onset of severe eye pain -Reduced central vision -Blurred vision -Ocular redness -Report of seeing halos around lights

When to call the physician in the middle of the night?

-Falls -Deteriorates significantly or dies -Has critical laboratory results -Needs a prescription that requires clarification -Leaves against medical advice or runs away -Refuses key treatments in a relevant period

Refeeding syndrome When does this happen? Complications?

-Fatal complication of nutritional rehabilitation in chronically malnourished clients (eg, anorexia nervosa, chronic alcoholism). -Rapid declines in phosphorus( 2.5 to 4.5), potassium, and/or magnesium (mnemonic PPM) - Past lack of oral intake - less insulin - After receiving food - insulin secretion is increased - Can lead to: Leads to phosphorus, potassium, and magnesium shifting intracellularly Hypophosphatemia causes muscle weakness and respiratory failure. Deficiencies in potassium and magnesium potentiate cardiac arrhythmias. Fluid overload Thiamine deficiency

Measles, mumps, rubella, and varicella (MMRV) vaccine Complication and management?

-Fever after MMRV vaccination can lead to febrile seizures -Administer acetaminophen for fever above 102 -Children with a history of seizures should be vaccinated with separate MMR and varicella vaccines instead of the combination MMRV vaccine

Nursing principles

-Fidelity is exhibiting loyalty and fulfilling commitments made to oneself and others -Nonmaleficence means to do no harm and relates to protecting clients from danger when they are unable to do so themselves due to a mental/physical condition -Autonomy is the right to make decisions for oneself (eg, informed consent) -Beneficence means to do good (eg, implementing interventions to promote the client's well-being -Justice refers to treating all clients fairly (ie, without bias) -Veracity is telling the truth as a fundamental part of building a trusting relationship

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Intervention?

-Fluid restriction to <1000 mL/day -Oral salt tablets to increase serum sodium -Hypertonic saline (3%) during the first few hours for clients with markedly decreased serum sodium and severe neurologic manifestations -Vasopressin receptor antagonists (eg, conivaptan)

Methylphenidate For? Side effects?

-For ADHD - Stimulant medications for ADHD - Other drugs for ADHD - Also amphetamines ( (eg, dextroamphetamine, lisdexamfetamine) - S/S Weight loss - growth delay Hypertension and tachycardia Vocal/motor tics Restlessness, insomnia Abuse of drug potential

Activated charcoal

-For aspirin toxicity - If this doesn't work, give IV sodium bicarbonate

Herpes zoster s/s

-Has a characteristic unilateral, linear pattern of fluid-filled blisters -Pain and itching - Caused by VZV virus which also causes chicken pox - Stays dormant after childhood, reactivates later, prevented with vaccination -Use gloves

Licorice

-Herbal remedy -May cause hypokalemia if taken with a potassium wasting diuretic

Positioning for different types of procedures: After a paracentesis After a liver biopsy Air embolus Chest tube insertion After lumbar puncture

-High fowler after paracentesis -Position on right side after liver biopsy -Air embolus, the head of the bed should be lowered (Trendelenburg) and the client positioned on the left side; -Chest tube insertion should be performed with the client's arm raised above the head on the affected side -After lumbar puncture - usually supine with bed at 30 degree

Mixing NPH with regular insulin

-Inject the NPH insulin vial with 20 units of air without inverting the vial or passing the needle into the solution. -Inject 6 units of air into the regular insulin vial and withdraw the dose, leaving no air bubble. -Draw NPH, totaling 26 units in one syringe. Any overdraw of NPH into the syringe will necessitate wasting the total quantity.

People with one-sided weakness and have a cane Characteristics of cane and how to move?

-Length of cane is distance from greater trochanter to the floor -Hold cane on the stronger side -Move stronger leg past cane and weak leg so weight is divided

Types of abnormal speeches Neologisms- ? Concrete thinking- ? Loose associations -? Echolalia -? Tangentiality -? Word salad-? Clang associations-? Perseveration-?

-Neologisms - made-up words or phrases usually of a bizarre nature; the words have meaning to the client only. Example: "I would like to have a phjinox." -Concrete thinking - literal interpretation of an idea; the client has difficulty with abstract thinking. Example: The phrase, "The grass is always greener on the other side," would be interpreted to mean that the grass somewhere else is literally greener ( -Loose associations - rapid shifting from one idea to another, with little or no connection to logic or rationality -Echolalia - repetition of words, usually uttered by someone else -Tangentiality - going from one topic to the next without getting to the point of the original idea or topic -Word salad - a mix of words and/or phrases having no meaning except to the client. Example: "Here what comes table, sky, apple." -Clang associations - rhyming words in a meaningless, illogical manner. Example: "The pike likes to hike and Mike fed the bike near the tyke." -Perseveration - repeating the same words or phrases in response to

Newborn normal vs

-Normal respiration: 30-60 -Apical rate normally 100-180/min -A physiologic heart murmur is expected in the first 48 hours Acrocyanosis in first 24h normal

acute appendicitis s/s

-Pain: Continuous; begins in the periumbilical region and then moves to the right lower quadrant centering at McBurney's point (one-third of the distance from the right anterior superior iliac spine to the umbilicus) - Gastrointestinal symptoms: Anorexia, nausea, and vomiting - Rebound tenderness and guarding

Pulmonary embolism s/s

-Pleuritic chest pain (ie, sharp lung pain while inhaling) -Dyspnea and hypoxemia Tachypnea and cough (eg, dry or productive cough with bloody sputum) -Tachycardia -Unilateral leg swelling, erythema, or tenderness related to deep vein thrombosis

Pica at risk for what?

-Pregnant women experiencing this disorder - craving of strange substances - HCP will oder lab for HCT and HGB due to high chance of iron deficiency anemia due to eating weird substances

Endotracheal suctioning Steps?

-Preoxygenate with 100% oxygen -Suction only while withdrawing -Use strict sterile technique -Limit suctioning to ≤10 sec

Fiber benefits

-Promotes weight loss due to early satiety -Regulates bowel movement - makes stool easier to pass

Minor sunburns Interventions

-Protect from further sun exposure -Increase fluid intake -OTC analgesics (acetaminophen and ibuprofen) -Cool compresses and soothing, protective lotions

Preeclampsia Interventions? s/s

-Seizures are potential complication, eclampsia -Seizure precautions -Check deep tendon reflexes; hyperreflexia or clonus -Calcium gluconate - reversal agent -Decrease environmental stimuli - decrease seizures - limit visitors/caregivers - proteinuria and hyppertension, edema

Varicella vaccination Side effects and their management

-Side effects discomfort, redness, and a few vesicles at the injection site - Covering the vesicles with clothing or a small bandage will reduce the risk of transmission from any exudate - Once dried or crusted, no longer needed

Trimethoprim- sulfamethoxazole(Bactrim

-Sulfa drug - antibiotic - For UTI - Contraindicated for pregnancy

CF

-Sweat gland abnormalities prevent sodium and chloride reabsorption, causing increased salt loss, dehydration, and hyponatremia during times of significant perspiration. Therefore, parents should increase the child's salt intake and fluids during hot weather, exercise, or fever

Brain lobes

-The occipital lobe of the brain registers visual images -The frontal lobe controls higher-order processing, such as executive function and personality. Injury to the frontal lobe often results in behavioral changes. -The temporal lobe integrates visual and auditory input and past experiences. -The parietal lobe integrates somatic and sensory input.

Tonsillitis trismus and its s/s

-Trismus- (Inability to open the mouth due to a tonic contraction of the muscles used for chewing) Require immediate intervention Indicate a peritonsillar or retropharyngeal abscess (collection of pus) -s/s of trismus A muffled "potato voice" Pooling of saliva Deviation of Uvula. Can occlude the airway

Heparin what lab? antidote?

-aPTT/PTT - Normal is 25-35 s; >100 is critical - Antidote - Protamine Sulfate - Short duration (approximately 2-6 hours IV)

Eye laceration - intervention

-cover BOTH eyes - due to synchronous movement - If you only cover the lacerated eye, and the uncovered eye moves, so will the damaged one

Meningitis symptoms s/s ? Risk for? s/s for infants and the most common acute problem?

-headache, neck stiffness, nausea, vomiting, photophobia, fever, and altered mental status. - Brudzinski sign - Neck flexion elicits pain and knee/hip flexion - Kernig sign - leg extension on 90 degree flexed hip causes pain and resistance - risk for seizures - s/s of child <2 age: Fever or possible hypothermia Irritability, frequent seizures High-pitched cry Poor feeding and vomiting Nuchal rigidity(an inability to flex the neck forward due to rigidity of the neck muscles) Bulging fontanelle possible but not always present Most common acute problem - hydrocephalus

The average hospital length of stay following total knee arthroplasty

-is 3-5 days -fully weight bearing by discharge

Cerebral Palsy

-is a group of disorders that affect a person's ability to move and maintain balance and posture. CP is the most common motor disability in childhood. Cerebral means having to do with the brain. Palsy means weakness or problems with using the muscles. - commonly have an implanted baclofen pump to help control muscle spasms. Increased spasms indicate a possible problem with the pump, such as infection or displacement. Baclofen should not be stopped abruptly

The placenta

-provides an exchange of oxygen, nutrients, and waste products between the mother and the fetus - Nutrients, medications, antibodies, and viruses can pass through the placenta.

Infant rolling off the bed

-the muscles required for rolling over do not develop until age 4-5 months. - If infant younger - suspicous

Nausea and vomiting with morphine sulfate

-tolerance develops quickly and persistent nausea is rare. It is recommended that the client take an anti-emetic with the pain medication. - Up to 40 % in clients can develop nausea and vomiting

Hyperbilirubinemia

. At any serum bilirubin level, the appearance of jaundice during the first day of life indicates a pathological process. Early and frequent feeding hastens the excretion of bilirubin

Levothyroxine x warfarin

. If thyroid hormone replacement therapy is instituted in a client who has been taking warfarin, the dosage of warfarin should be reduced.

Bilirubin

0.2 - 1.2 Jaundice, scleral icterus, itching

Bilirubin

0.2-1.2

Digoxin level

0.5- 2.0

Creatinine

0.6 - 1.3

Piaget's Theory of Cognitive Development

1. Learning by sense and movement, exploration, early verbal skills 2. Improved language, poor causality (eg. magical thinking), egocentrism 3. Able to reason if concrete objects are used to teach 4. Abstract thinking and reasoning

Lungs sounds and their meaning 1. Bronchial breath sounds at lung periphery 2. Clear vesicular breath sounds at lung bases 3. Diffuse bilateral crackles at lung bases 4. Stridor in upper airways

1. presence of these on lung periphery indicates pneumonia (consolidation). 2. Normal breath sounds 3. Pulmonary edema 4. Stridor is consistent with a laryngospasm or edema of the upper airway

Urine Specific Gravity

1.003 to 1.030

The proper method of delivering a dose via MDI(metered-dose inhaler) includes the following steps:

1.First shake MDI and attach it to the spacer. 2.Exhale completely to optimize inhalation of the medication. 3.Place lips tightly around the mouth piece. 4.Deliver a single puff of medication into spacer. 5.Take a slow, deep breath and hold it for 10 seconds to allow for effective medication distribution. 6.After the dose, rinse mouth with water to remove any leftover medication from oral mucous membranes. Spit out the water to ensure no medication is swallowed

Steps to - Assessment of a sleeping infant

1.Observation 2.Auscultation 3.Palpation and percussion 4.Traumatic procedures (examine eye, ear, mouth) 5.Elicit reflexes

Endotracheal tubes (ETTs) Steps for suctioning

1.Perform hand hygiene and don clean gloves (Option 5). 2.Suction the oropharynx and perform oral care (Option 6). 3.Ensure that the system is connected to appropriate wall suction (<120 mm Hg). 4.Hyperoxygenate the lungs (100% FiO2) (Option 4). 5.Advance the catheter into the trachea just until resistance is met (level of the carina) (Option 1). Do not suction while advancing the catheter. 6. Gently remove the catheter while suctioning and rotating it. Do not suction for more than 10 seconds (Option 3). 7. Evaluate client tolerance; if further secretions remain, suctioning can be repeated 1 or 2 times. Document the procedure when complete (Option 2). 8. Resume oxygenation and ventilation settings as prescribed.

Hemoglobin (female)

11.7-15.5 g/dL

FHR

110-160

Fetal sex known by

12 weeks

Hemoglobin (male)

13.2-17.3 g/dL

Prealbumin

15-36 mg/dL

Ammonia level

15-45

Serum ammonia

15-45

Pneumococcal vaccinations

2 shots 1 year apart

Phosphorus antidote for toxicity?

2.4-4.4 Hyperphosphatemia - antidote is Calcium acetate

Potassium

3.5 - 5.0

Albumin

3.5-5

1 lb = how many calories?

3500 calories

Hematocrit (male)

39-50

Cardiac output

4-8L

Hypothyroidism is diagnosed, and levothyroxine is prescribed. What is an expected outcome of the medication?

4. Achieve normal thyroid hormone levels

Normal PAWP(Pulmonary Artery Wedge Pressure)

6-12

BUN

6-20

Normal pulse

60-100

Legal alcohol level

80

Systemic vascular resistance (SVR)

800-1200

Diarrhea

< 48 is ok. Over 48 hours needs to see physician

LDL

<100 mg/dl

Fasting glucose

<140 For critically ill: 140-80

Random blood glucose

<180

Tachysystole

>5 contractions in 10 min

Cyanide poisoning

A bitter almond smell

Presbyopia

A gradual, age-related loss of the eyes' ability to focus actively on nearby objects.

Hemophilia

A hereditary disease where blood does not coagulate to stop bleeding

Respiratory rate

A marked decrease in respiratory rate or increased work of breathing may indicate respiratory fatigue, and immediate intervention is needed. Impending respiratory failure is the immediate priority. - For instance, after drowning and CPR, RR decreased from 61 to 18

Hyperopia

A vision condition in which nearby objects are blurry.

Contraceptive use side effects

ACHES - abdominal pain - ischemic bowel - Chest pain - pulmonary embolism or myocardial infarction - Headaches - stroke - Eye problems - retinal blood vessel ischemia - Severe leg pain - deep venous thromboembolism

Treatment of overdose of drugs

Activated charcoal

Left to right sided heart shunt

Acyanotic defects Tachypnea Tachycardia, even at rest Diaphoresis during feeding or exertion Heart murmur or extra heart sounds Signs of congestive heart failure Increased metabolic rate with poor weight gain

When to administer narcotics during labor

Administering IV narcotics during peak of contraction can help decrease sedation of the fetus and subsequent newborn respiratory depression

Atorvastatin Side effects?

Adverse effect of statins - rhabdomyolysis (is a serious syndrome due to a direct or indirect muscle injury. It results from the death of muscle fibers and release of their contents into the bloodstream. This can lead to serious complications such as renal (kidney) failure) - myopathy with generalized muscle aches and weakness - Contact HCP - high creatine kinase - Damages kidney - Liver function test - statins given at bedtime - better results

Addison's disease

Aldosterone deficiency causes hyponatremia and hyperkalemia. Clients should not restrict dietary sodium and may need increased sodium and water intake, especially during illness, on hot days, or during periods of increased exertion. The client should avoid excess intake of potassium - Carrying and learning to administer an emergency steroid injection (eg, dexamethasone, hydrocortisone)

myomectomy

Also known as an "open" myomectomy, an abdominal myomectomy is a major surgical procedure. It involves making an incision through the skin on the lower abdomen, known as a "bikini cut," and removing the fibroids from the wall of the uterus.

Anorexia nervosa x Bulimia nervosa

Anorexia: - Significant low weight - Intense fear of gaining weight/distorted body image - Subtupes: Binge/purge; Restricting (diet, fasting, excessive exercise) - Lanugo Bulimia: - Weight within or above normal range - Preoccupation with weight and shape - Binge eating and compensatory behavior (purging, exercise, fasting, laxatives)

Aluminium hydroxide

Antacid

Amiodarone

Antiarrhythmic - Pulmonary toxicity is a life-threatening adverse effect

Fondaparinux

Anticoagulant

A client that keeps on pulling IV

Apply gauze wrap and elastic stockinette around the IV site

Initial interventions in emergency management of chest pain are as follows:

Assess airway, breathing, and circulation (ABCs) Position client upright unless contraindicated Apply oxygen, if the client is hypoxic Obtain baseline vital signs, including oxygen saturation Auscultate heart and lung sounds Obtain a 12-lead electrocardiogram (ECG) Insert 2-3 large-bore intravenous catheters Assess pain using the PQRST method Medicate for pain as prescribed (eg, nitroglycerin) Initiate continuous electrocardiogram (ECG) monitoring (cardiac monitor) Obtain baseline blood work (eg, cardiac markers, serum electrolytes) Obtain portable chest x-ray Assess for contraindications to antiplatelet and anticoagulant therapy Administer aspirin unless contraindicate

Case manager

Assess, plan, facilitate and advocate for clients

Collaborative interventions for cholecystitis

Assess: Pain, stools, nutritional status and gastrointestinal symptoms Maintain: NPO, NG tub to low suctioning, Semi-fowler Administer: Fluids with electrolyte replacement

Client on a mechanical ventilator needs an ABG What not to do?

Avoid suctioning the client 20 min prior to the blood draw as it may affect results

Baby reflexes Babinski Plantar Reflex Moro Reflex Tonic Neck Reflex Galant (Truncal Incurvation) Reflex Stepping Reflex Rooting Reflex Grasp Reflex

Babinski Plantar Reflex (Present at birth through 1 yearStroke upward from heel and across footShould see dorsiflexion of big toe and fanning of toes.) Moro reflex (Birth to 8 weeks, then decrease in total reaction.Can elicit with loud noise, or a slight dropping of the head) Tonic Nect Reflext (Infant supine, turn head to one side - the arm and leg will extend on the side the baby is facing and flex on the opposite.) Galant Reflex (Infant prone, rung finger down back about 4-5 cm lateral to spine. Check each side. Infant flexes toward stimulus. Usually present 5-6 days of age.) Stepping Relfex (Hold infant vertically under arms. Allow one foot to touch the table. Infant will simulate walking, alternating flexion and extension of feet. Reflex present 3-4 weeks.) Rooting Reflex (Touch infants lip, cheek or corner of mouth with nipple or finger. Infant turns toward it and opens mouth. State Dependent.) Grasp Reflex (Birth to 3-4 months.Place finger in palm of hand. Infants fingers curl around examiners fingerPlace finger at base of toes. Toes curl downward.)

Piaget's theory of cognitive developement

Birth to 2: Learning by sense and movement, exploration, early verbal skills 2-7: Improved language, poor causuality (eg. magical thinking), egocentrism 7-11: Able to reason if concrete objects are used to teach 11+: Abstract thinking and reasoning

Birth weight

Birth weight doubling by age 6 months and tripling by age 12 months; first year, birth length increases by approximately 50%

Colorectal cancer s/s

Blood in stool Abdominal discomfort Anemia due to intestinal bleeding Change in bowel habits Unexplained weight loss

Cataract type of vision loss?

Blurry vision Cloudiness

Coup

Brassy cough

Anyphylactic shock management

Call for help (activate emergency management systems) - first action Maintain airway and breathing - administer high-flow O2 via non-rebreather mask Epinephrine, intramuscular - the drug of choice and should be given next. Epinephrine stimulates both alpha- and beta-adrenergic receptors, dilates bronchial smooth muscle (beta 2), and provides vasoconstriction (alpha 1). The IM route is better than the subcutaneous route. The dose should be repeated every 5-15 minutes if there is no response. Elevate the legs Volume resuscitation with IV fluids Bronchodilator such as albuterol is administered to dilate the small airways and reverse bronchoconstriction Antihistamine (diphenhydramine) is administered to modify the hypersensitivity reaction and relieve pruritus Corticosteroids (methylprednisolone [Solu-Medrol]) are administered to decrease airway inflammation and swelling associated with the allergic reaction

Methadone

Can cause lethal arrhythmias

Gonorrhea and chlamydia

Can lead to inflammatory disease and infertility

4 years old

Cannot jump rope (at 5) Preschoolers usually cannot sit quietly for 30 min - 3 (draw circle), 4 (draw square), 5 (draw triangle)

tricyclic antidepressants side effects

Cardio - Dizziness, orthostatic hypotension -> falling Anticholinergic - dry mouth, constipation, urinary retention and/or difficulty initiating a urinary stream, blurred vision Neuro - Drowsiness, confusion Dermatological - photosensitivity

Side effects & nursing interventions for clients taking tricyclic antidepressants

Cardio: Dizziness, orthostatic hypotension Anticholigernic: Dry mouth, constipation, urinary retention and/or difficulty initiating a urinary stream, blurred vision Neurological: Drowsiness, confusion Dermatological: Photosensitivity

Aspirin Side effects?

Cause tinnitus and hyperthermia

C diff causes?

Causes watery diarrhea, nausea, fever, and abdominal pain - Can cause hypovolemia through loss of fluid - hyponatremia, hypokalemia, and elevated blood urea nitrogen (BUN) (poor renal perfusion) -

Gastric residual volumes Check how often? Interventions regarding feedings

Check q4h Flushed before and after feedings

Pleural effusion

Chest pain with respiration

TB administration

Choose a 1 mL tuberculin syringe with a 27-gauge 1/4 inch needle then don clean gloves - the syringe is calibrated in hundredths of a millimeter and the intradermal needle is short enough to remain in the dermis with length range of 1/4-5/8 inch (Option 2). Position the left forearm to face upward, and cleanse site that is a hands width above the wrist - the left arm is commonly used for TB testing; the forearm has little hair and subcutaneous tissue and is readily accessible to observe a skin reaction. Place non-dominant hand 1 inch below the insertion site and pull skin downward so that it is taut - taut skin makes it easier to insert the needle and promotes comfort. Insert the needle almost parallel to skin at a 10-degree angle with bevel up - this is important as the medication can enter the subcutaneous tissue if the angle is >15 degrees (Option 4). Advance the tip of the needle through epidermis into dermis; outline of bevel should be visible under the skin - verify that the medication will be injected into dermis (Option 1). Inject medication slowly while raising a small wheal (bleb) on the skin - verify that the medication is being deposited into the dermis (Option 3). Remove needle and do not rub the area - rubbing promotes leakage through the insertion site and medication deposition into the tissue. Circle the area with a pen to assess for redness and induration (according to institution policy) - this delineates the border for measurement of reaction.

Psoriasis triggers? type of therapies?

Chronic skin condition producing red lesions covered with silvery scales - Avoidance of triggers (eg, stress, trauma, infection) - Topical therapy (eg, corticosteroids, moisturizers), phototherapy (eg, ultraviolet light), and systemic medications

Polypharmacy adverse drug affect prevention

Clients should be encouraged to bring all medications (ie, prescription, over-the-counter [OTC], herbal supplements) they take regularly and occasionally to each appointment so that potential drug interactions can be evaluated

Umbilical cord prolapse

Cord compression caused by a prolapsed cord will produce abrupt fetal heart rate deceleration, fetal bradycardia, and disruption of fetal oxygen supply. The priority action is to inspect the vaginal area and perform a sterile vaginal examination to assess for a prolapsed cord

Rapid response team when to call

Critical care expertise to the bedside of clients demonstrating early signs of deterioration such as dyspnea, confusion, and restlessness

What to include in a client hand off report?

Current info and objective

Thrombin inhibitors

Dabigatran (Pradaxa), Efegatran. Inogatran§ Melagatran‡ Ximelagatran - Bleeding precautions - Kept in their original container or blister pack until time of use to prevent moisture contamination

Food

Dairy products (eg, milk, yogurt) and certain fruits (eg, bananas, oranges, coconuts, watermelons, and avocados) contain high potassium levels. Dairy products also contain high phosphorus levels. - Examples of allowable foods for CKD clients include apples, pears, grapes, pineapple, blackberries, blueberries, and plums.

melena stool

Dark tarry stools contained decomposing blood - indicate UGI bleed

Meripidine

Demerol

Stages of grief

Denial - Denies illness, severity, or prognosis Anger - Directly expressed or may be displaced onto physician or others Bargaining - Tries to "strike a bargain" in return for surviving illness Depression - Becomes sad, detached, hopeless Acceptance - Comes to terms with impending death, "at peace"

Mitral stenosis and aortic regurgitation s/s

Diastolic murmur

After a sexual assault ask what?

Did she dough or had a bath or shower? - compromises evidence

Central Line

Discard the first batch is to prevent inaccuracy in lab result not for infection purposes

A person that reports being fatigued every day and gaining weight lately despite not eating lunch

Doesn't mean HF but can also be hypothyroidism

Lindane

Don't give for kids under 2 For scabies

Toddlers

Don't give raw fish/veggies/unwashed fruits - risk for food-related infection -Catching a ball 50% of the time is a developmental expectation for a 4-year-old. - A 4-year-old can copy or draw a square with a pencil or crayon -Hopping on one foot is a developmental expectation for a 4-year-old.

Hypovolemic shock

Don't raise the head of bed - brain perfusion

Chest tube drainage

Drainage >3 mL/kg/hr for 3 consecutive hours or >5-10 mL/kg in 1 hour should be reported immediately to the health care provider

Substernal chest pain

Draw blood to look for electrolyte balance etc

Naegele's rule

EDB = (LMP minus 3 months) + 7 days LMP - last normal menstrual period

Increased ICP interventions

Elevating head, neutral position -Administering stool softeners -Managing pain -Managing fever -Maintaining a calm environment -Adequate oxygenation -Hyperventilating and preoxygenating before suctioning (Reduce C02 -> induces vasoconstriction and reduces ICP)

CK-MB

Elevation indicate MI

Pyloric stenosis

Emesis is nonbilious (formula in/formula out) and leads to progressive dehydration. Infants will be hungry constantly despite regular feedings. A hematocrit of 57% (0.57) is elevated and indicative of hemoconcentration caused by dehydration. Elevated blood urea nitrogen is also a sign of dehydration.

Management of anaphylactic shock interventions?

Ensure patent airway, administer oxygen Remove insect stinger if present IM epinephrine is the drug of choice and should be given to this client. Epinephrine stimulates both alpha- and beta-adrenergic receptors and dilates bronchial smooth muscle (beta 2) and provides vasoconstriction (alpha 1). The IM route (mid anterior lateral thigh) is better than the subcutaneous route. Repeat dose every 5-15 minutes. Place in recumbent position and elevate legs Maintain blood pressure with IV fluids, volume expanders or vasopressors Bronchodilator (inhaled beta agonist) such as albuterol is administered to dilate the small airways and reverse bronchoconstriction Antihistamine (diphenhydramine) is administered to modify the hypersensitivity reaction and relieve pruritus Corticosteroids (methylprednisolone [Solu-Medrol]) are administered to decrease airway inflammation and swelling associated with the allergic reaction Anticipate cricothyrotomy or tracheostomy with severe laryngeal edema

Different cells and their elevation during which situation? Eosinophils Lymphocytes Neutrophils Reticulocytes Basophils

Eosinophils - allergy Lymphocytes - viral and hematologic malignancies Neutrophils - infection Reticulocytes - are immature RBC.Normal reticulocyte count is 0.5%-2.0%. Levels are elevated in hemolytic anemia or hemorrhage when the marrow is attempting to compensate for lost blood. Basophils - allergic reaction also

Guaifenesine (Robitussin) For?

Expectorant that reduces the viscosity of thick secretions

Factor Xa inhibitors (eg, rivaroxaban [Xarelto], edoxaban, apixaban) For? Contraindications?

Factor Xa inhibitors - are anticoagulants used to prevent and treat venous thromboembolism - Avoid NSAIDs (eg, aspirin), garlic, and ginger

Infertility When is this diagnosed?

Fails to conceive after 12 months (women age <35) or 6 months(women age ≥35)

Anorexia nervosa s/s

Fear of weight gain Fluid and electrolyte imbalance Amenorrhea Decreased metabolic rate Lanugo - fine terminal hair) can be seen in extreme cases

Hepatitis A

Fecal oral route

Smallpox

Fever and raised skin pustules

Common causes of benign proteinuria?

Fever, strenous exercise, and prolonged standing

Colostomy irrigation

Fill the irrigation container with 500-1000 mL of lukewarm water, flush irrigation tubing, and reclamp; hang the container on a hook or intravenous pole (Option 2) Instruct the client to sit on the toilet, place the irrigation sleeve over the stoma, extend the sleeve into the toilet, and place the irrigation container approximately 18-24 inches above the stoma (Option 3) Lubricate cone-tipped irrigator, insert cone and attached catheter gently into the stoma, and hold in place Slowly open the roller clamp, allowing irrigation solution to flow for 5-10 minutes Clamp the tubing if cramping occurs, until it subsides (Option 4) Once the desired amount of solution is instilled, the cone is removed and feces is allowed to drain through the sleeve into the toilet

Cerebellum test

Finger tapping - ability to touch each finger of one hand to the hand's thumb (Option 4). Rapid alternating movements - rapid supination and pronation Finger-to-nose testing - clients touch the clinician's finger and then their own nose as the clinician's finger varies in location Heel-to-shin testing - client runs each heel down each shin while in a supine position Heel-to-toe (tandem), on toes, and on heels

The proper method of delivering a dose via MDI(metered-dose inhaler)

First shake MDI and attach it to the spacer. Exhale completely to optimize inhalation of the medication. Place lips tightly around the mouth piece. Deliver a single puff of medication into spacer. Take a slow, deep breath and hold it for 10 seconds to allow for effective medication distribution. After the dose, rinse mouth with water to remove any left-over medication from oral mucous membranes. Spit out the water to ensure no medication is swallowed

Long-acting nitrate isosorbide mononitrate

For chronic stable angina

"silent" asthma. S/s

Frequent cough, especially at night, is the warning signal that the child's airway is very sensitive to stimuli; it may be the only sign in "silent" asthma.

Loop diuretic

Furosemide, torsemide, bumetanide

GTPAL

G-Gravida - the number of times a woman has been pregnant, regardless of pregnancy outcome T-Term -The number of pregnancies delivered at 37 w 0 d gestation and beyond P - preterm - the number of pregnancies delivered from 20 w 0 d gestation through 36w 6 d gestation A - Abortion - The number of pregnancies ending before 20w 0 d gestation; these may be spontaneous (miscarriage) or induced abortions L- Living - The number of currently living children - Can be shortened to GP - gravida (ie, number of previous pregnancies) and para (ie, number of births after 20 weeks)

Metabolic acidosis what can cause this

GI bicarbonate losses (eg, diarrhea) Ketoacidosis (eg, diabetes, alcoholism, starvation) Lactic acidosis (eg, sepsis, hypoperfusion) Renal failure (eg, hemodialysis with inaccessible arteriovenous shunt) Salicylate toxicity

Cholelithiasis

Gallstones in the gallbladder

Herpes

Genital vesicles/ulcers

Herbal supplements that can increase the risk for bleeding

Gingko biloba Garlic Ginseng Ginger Feverfew

Herbal supplements

Ginko biloba - memory enhancement - increased bleeding risk Gingseng - Improved mental performance - increased bleeding risk Saw palmetto - BPH - mild stomach discomfort, increased bleeding risk Black cohosh - postmenopausal symptoms (hot flashes and vaginal dryness) - hepatic injury St John's wort - Depression, Insomnia - Drug interactions: Antidepressants, OCs, anticoagulants(decrease INR), digoxin; hypertensive crisis Kava - Anxiety, Insomnia - severe liver damage Licorice - Stomach ulcers, Bronchitis/viral infections - Hypertension, hypokalemia Echinacea - Treatment and prevention of cold and flu - anaphylaxis (more likely in asthamatics) Ephedra - Treatment of cold and flu, Weight loss and improved athletic performance - Hypertension, Arrhythmia/MI/ sudden death, stroke, seizure OCs - contraceptives

Atropine For?

Give when low BP with bradycardia

Remove PPE

Gloves, Goggles/Face shield, Gown, Mask or respirator

CBC normal values for adults

HMC Male: 39-50 Female: 35-47 HGB Male: 13-17 Female: 12-15.5 WBC: 4000-11000

Neonatal resuscitation algorithm

HR < 60 - IV epinephrine, continue compression, continue ventilation

General anethesia and low oxygen saturation

Head tilt and chin lift is a maneuver used to open the airway. The tongue may fall back and occlude the airway due to muscular flaccidity after general anesthesia. Manifestations associated with airway obstruction include snoring, use of accessory muscles, decreased oxygen saturations, and cyanosis.

Magnesium

Hyperreflexia or clonus may indicate impending seizure activity, whereas hyporeflexia may indicate magnesium toxicity. Calcium gluconate is the reversal agent administered in the event of magnesium toxicity and should be immediately available

Zolpidem

Hypnotic

Types of needles used in different types of injection IM ID SQ

IM - 90°,Deltoid/Vastus lateralis/Ventrogluteal; 18-25; 1-1 1/2 in ID - 15°, Inner forearm; 25-27; 1/4 - 5/8 in SQ - 90° - 45° depending on amount of fat tissue; Abdomen/ Posterior upper arm/ Thigh; 25-27; 3/8 - 5/8 in

Warfarin lab? antidote?

INR - The therapeutic range for aPTT or PT/INR is generally 1.5-2.0 times the control value - INR normal is 46-70 s - Vitamin K is the antidote for warfarin - During treatment avoid - Broccoli, spinach, liver - Banana is rich in Potassium not Vitamin K, so you can it them - Antibiotics may affect - 48-72 hours to take effect - Thus often heparin is given with warfarin. For 5 days or until the INR reaches therapeutic level - heparin and warfarin will not break down or dissolve clots, they inhibit further clot formation - Thrombolytics break down clots - Ginkgo, garlic, and ginseng (the 3 Gs) increase bleeding risk when taken with anticoagulants or thrombolytics.

INR/PT normal

INR - 0.75 - 1.25 PT: 11/16s

TB test

In a heathy client, an induration >15 mm indicates a positive TST; this means that the client was exposed to TB, developed antibodies to the disease, and has a TB infection. Additional tests are needed to determine if the client has latent TB infection (LTBI) or active TB disease. Clients with LTBI are asymptomatic and cannot transmit the microorganism to others. Clients with active TB disease usually are symptomatic and can transmit the microorganisms through the air.

Drug/supplements that affect warfarin

Increases effect - Acetaminophen, NSAID; Antibiotics/antifungal agents, Amiodarone, Cranberry juice, ginkgo biloba, vitamin E, Omeprazole, Thyroid hormone, SSRI

Preterm infants

Infants born at preterm gestation have less time in utero to accumulate iron. Preterm infants typically deplete iron stores by age 2-3 months and require additional iron supplementation (eg, oral iron drops, iron-fortified formula). Therefore, a 3-month-old infant born at preterm gestation who is exclusively receiving breastmilk is most at risk for anemia

Cystitis

Inflammation of the bladder This inflammatory process leads to burning with urination (dysuria), urinary frequency and urgency, hematuria, and suprapubic discomfor

Diabetic ketoacidosis

Initial treatment is normal saline Afterwards regular insulin IV

Bubbling in the water seal chamber

Intermittent (not constant) bubbling is normal

intussuscpetion - s/s? treatment? can lead to?

Intestine telescoping into itself - Stools mixed with blood and mucus (red, "currant jelly") Sausage shaped abdominal mass Causes bilious, nonprojectile vomiting - Rreatment- Reduced with hydrostatic enema or air enema - Lead to Peritonitis -Infection of abdomen-Fever, abdominal rigidity, guarding, and rebound tenderness

tardive dyskinesia

Involuntary movement of - lip, tongue; grimace, brow furrow or twitch, excess blinking; foot tap, hand wringing, tremor or shake; rocking, torticollis (persistent neck flexion or extension)

Trisomy 18 (Edwards Syndrome)

Is a life-threatening chromosomal abnormality that affects multiple organ systems - eventually die Individuals with trisomy 18 often have slow growth before birth (intrauterine growth retardation) and a low birth weight. Affected individuals may have heart defects and abnormalities of other organs that develop before birth. Other features of trisomy 18 include a small, abnormally shaped head; a small jaw and mouth; and clenched fists with overlapping fingers. Due to the presence of several life-threatening medical problems, many individuals with trisomy 18 die before birth or within their first month. Five to 10 percent of children with this condition live past their first year, and these children often have severe intellectual disability.

Azathioprine For?

Is an immunosuppressant. Increased risk for infection

An emancipated minor

Is an individual under the age of legal responsibility who has been legally freed from parental control through a court order (eg, due to enlistment in the military, marriage, pregnancy).

Pelvic inflammatory disease

Is an infection of the female reproductive organs. It usually occurs when sexually transmitted bacteria spread from your vagina to your uterus, fallopian tubes or ovaries

Sickle cell disease

Ischemic strokes are common

why the fertilized ovum stays in the fallopian tube for 3 days

It promotes the fertilized ovum's normal implantation in the top portion of the uterus.

Orthodox Judaism (Jews) diet?

Kosher Diet - No pork, shellfish, fish without scales and the separation of meat/poultry from dairy - When meat consumed, at least 3-6 hours must pass before a dairy product is consumed.

Macular degeneration type of vision loss?

Loss of central vision

First manifestation of radiation exposure

Low blood cell count, oral mucosa ulceration, vomiting and diarrhea

TB s/s general one

Low-grade fever Night sweats Anorexia and weight loss Fatigue Other signs depend on location

Leukorrhea begins during the first trimester

Many clients notice a thin, colorless or yellow vaginal discharge throughout pregnancy. Some clients become distressed about this condition, but it does not require that the client report to the health care clinic or emergency department immediately.

Sepsis neonatorum

Medical emergency Infection Elevated temperature or be hypothermic irritability, increased sleepiness, and poor feeding

Cranial nerves I, II, III, IV, V, VI, VII, VIII, IX, X, XI, XII mnemonic?

Mnemonic - On Old Olympus Towering Tops A Finn And German Viewed Some Hops Some Say Marry Money But My Brother Says Bad Business Marry Money I - Olfactory - Smell test II - Optic -Visual acuity and visual fields III - Oculomotor- Pupil constriction and extraocular movements IV - Trochlear- Extraocular movements - inferior adduction V - Trigeminal -Clench teet and light touch VI - Abducens- Extraocular movements - lateral obduction VII - Facial - Facial movements - close eyes, smile VIII - Acoustic- Hearing and Romberg Test IX - Glossopharyngeal- Gag reflex X - Vagus - Say "ah" - uvular and palate movement XI - Spinal accessory- Turn head and lift shoulders to resistance XII - Hypoglossal - Stick out tongue - Impairment in Cranial VIII - loss of hearing, dizziness, vertigo, and motion sickness, which place the client at a high risk for falls. Impairment in X - Listens to voice quality; Harsh or brassy voice quality indicates dysfunction with the vagus nerve

Developmental milestones of infants

Month 2-3 - gains head control wen heal; holds rattle when placed in hand; makes cooing sounds; smiles in response to smiling and talking Month 4-5 - rollds fron to back, then back to front; sits with support; holds objects with palmar grasp; puts things in mouth; Month 6-9 - Sits without help; beings to crawl; may pull to a stand; moves objects between hands; Uses crude pincer grasp; babbles and imitates sounds; may say "mama" Month 10-12 - May walk with help or take independent steps; crawl up stairs; uses 2 finger pincer grasp; hits 2 objects together; says 3-5 words; uses nonverbal gestures (waving goodbye); may have separation anxiety, searches for hidden objects

Corticosteroids

Mood swings and irritability are common side effects

Muscle relaxant medications

Most of them are metabolized in the LIVER

Spinal immobilization When indicated

N - Neurological examination. Focal deficits include numbness and decreased strength. S - Significant traumatic mechanism of injury A - Alertness. The client may be disoriented or have an altered level of consciousness (Option 2). I - Intoxication. The client could have impaired decision-making ability or lack awareness of pain (Option 1). D - Distracting injury. Another significant injury could distract the client from spinal pain. S - Spinal examination. Point tenderness over the spine or neck pain on movement (if there is no midline tenderness) may be present

Acute pancreatitis

NPO, Pain management, IV fluids

Neonatal resuscitation algorithm

NRP dictates that positive pressure ventilation (PPV) be started when a newborn's heart rate is <100/min. -Effective PPV will often result in a rising heart rate and return of spontaneous respirations.

Carbon monoxide poisoning test? intervention?

Need to do a carboxyhemoglobin test - Normal <5 - 10% (smoker) - Give 100% oxygen using a non rebreather mask

Mixing of glargine and other insulins

Never

Mormon diet?

No alcohol, coffee and tea

Chickenpox

No longer contagious after the lesions have crusted and dried

BPH characteristics

Nocturia, incontinence, and an enlarged prostate

Eczema

Noninfectious, inflammatory skin disease Characterized by redness, blisters, scabs, and itching

A client is at risk for suicide

Nurse: Provide authority, action, and participation. . The person who intervenes in this situation (the nurse) "takes over" for the client (authority) who is not in control and devises a plan (action) to secure and maintain the client's safety.

Uterine tachysystole

Occurs when contractions are too frequent (>5 in 10 minutes). It is sometimes associated with abnormal fetal heart rate (FHR) patterns because too-frequent contractions may cause inadequate reperfusion of the uterus and placenta due to shortened resting intervals between contractions.

Ovarian cancer s/s ?

Often subtle and may include abdominal bloating; pelvic pain or pressure; abdominal girth increase; early satiety; abdominal, back, or leg pain; urinary urgency/frequency; and gastrointestinal disturbances

STAT order

Only once Need to reorder to give it again

Splenectomy At risk for what post-procedural?

Overwhelming postsplenectomy bacterial infection or rapid-onset sepsis are major lifelong complications in a client without a functioning spleen

Postoperative pneumonia intervention

Pain control Ambulate within 8 hours Cough with splinting q1h Incentive spirometer Swab mouth with chlorhexidine q12h Hand hygiene

Syphilis

Painless genital ulcers

Positioning for procedures

Paracentesis - semi to high fowler in preperation for procedure After cardiac catheterization via femoral entry - lay flat or low fowler position

(eg, tadalafil, sildenafil, vardenafil) For? Precautions?

Phosphodiesterase inhibitors - For erectile dysfunction - are contraindicated with the use of nitrates - Both have similar mechanisms and cause vascular smooth muscle dilation. Combined use can result in severe hypotension

pulsus paradoxus

Place client in semirecumbent position Have client breathe normally Determine the SBP using a manual BP cuff Inflate the BP cuff to at least 20 mm Hg above the previously measured SBP Deflate the cuff slowly, noting the first Korotkoff sound during expiration along with the pressure Continue to slowly deflate the cuff until you hear sounds throughout inspiration and expiration; also note the pressure Determine the difference between the 2 measurements in steps 5 and 6; this equals the amount of paradox The difference is normally <10 mm Hg, but a difference >10 mm Hg may indicate the presence of cardiac tamponade

Total knee replacement pillow?

Placing a pillow behind the knee causes joint flexion, which increases the risk of contracture

Jehovah's witnesses Prevent shock?

Prevent shock - saline, lactated Ringer's, dextran, and hetastarch

Panic attacks priority intervention

Priority intervention is to stay with client and ensure safety

Tetralogy of Fallot Interventions to reduce incidences

Providing a calm environment, particularly on waking (Option 3) Soothing and quieting the infant when crying or distressed Offering a pacifier (Option 2) Swaddling or holding the infant during procedures or times of stress (Option 4) Providing frequent smaller feedings to reduce frustration due to hunger and limit sucking fatigue

Approach to sinus bradycardia

Pulse <50 and symptomatic (dizziness) ->Identify and treat cause/ IV access, cardiac monitoring/ 12 lead ECG/ Pulse oximetry -> Persistent bradyarrhythmia and one of the following (Hypotension or signs of shock, Acute mental status Change, Chest discomfort concerning for cardiac ischemia, acute heart failure) -> IV atropine 0.5 mg bolus, repeat every 3-5 min up to 3.0 mg maximum -> No response? Transcutaneous pacing OR IV dopamine OR IV epinephrine -> No response? Consider expert consultation or transvenous pacing

Antihypertensives are held before dialysis

Random note

Defense mechanisms Rationalization Displacement Regression Introjection Reaction formation Repression Sublimation

Rationalization - excuses to explain away threatening circumstances Displacement - Transferring thoughts and feelings toward one person or object onto another person or object Regression - returning to a previous level of development Introjection - taking on the qualities or attitudes of others without though or examination Reaction formation - Behaving in a manner or expressing a feeling opposite of one's true feelings Repression - Keeping unacceptable thoughts or traumatic events buried in the unconscious Sublimation - transforming unacceptable thoughts or needs into acceptable actions

Refusal of spouse to let us talk to the patient What to do in that situation?

Reach the client by phone 3 times, then by certified letter, and (depending on the seriousness of the result) then sending the police to contact the client

Minimally invasive CABG How is it different from standard CABG?

Recovery time is typically shorter with these procedures and clients are able to resume activities sooner than with traditional open chest coronary artery bypass graft surgery. However, clients may report higher levels of pain with MIDCAB due to the thoracotomy incisions made between the ribs

Wet client with a transdermal patch about to get AED

Remove the patch and dry the patient

Growth hormone replacement

Replacement therapy is not continued throughout a child's life. It is stopped when bone growth begins to cease or when the child, parents, and provider make the decision

Cast care

Report foul odors or hot areas (hot spots) in the cast, which may indicate infection (Option 1). Avoid getting the cast wet, which may damage the cast and cause skin irritation/infection (Option 2). Elevate the affected extremity above heart level for the first 48 hours to reduce edema (Option 3). Regularly perform isometric and range of motion exercises to prevent muscle atrophy. - never insert objects inside the cast due to the risk of tissue injury and infection. Directing air inside the cast with a hair dryer on the cool setting may help relieve itching.

Alzheimer disease x lifestyle choices

Research suggests that healthy lifestyle choices (eg, smoking cessation, avoiding excessive alcohol intake, exercising regularly, participating in mentally challenging activities) reduce the risk for developing AD

Sprain management

Rest Ice Compression Elevation Analgesia Exercise rehabilitation program

Rhonchi Asthma Croup Pleurisy sounds

Rhonchi- (ie, sonorous wheeze) are continuous, low-pitched adventitious breath sounds that occur when thick secretions or foreign bodies (eg, tumors) obstruct airflow in the upper airways. The resulting sound resembles moaning or snoring and is heard primarily during expiration but may also be present during inspiration. Asthma - typically manifests with high-pitched, musical wheezes caused by airway narrowing Coup - manifests with stridor, a high-pitched inspiratory breath sound that can often be heard without using a stethoscope. Stridor is caused by partial obstruction of the upper airway and is often louder over the throat.(aspiration of a foreign object, anaphylaxis, epiglottitis) Pleurisy - manifests with pleural friction rub, a loud, rough rubbing or grating sound heard throughout inspiration and expiration that is caused by the pleural surfaces rubbing together. Pleural friction rub sounds similar to crackles, but crackles are typically heard only during inspiration

Positive pressure ventilation risk for?

Risk of hypotension

Normal postpartum lochia

Rubra: Birth to 3-4 days. Bright red Seroa: 4 to 10-14 days. Serosanguineous (pink); brownish (old blood) Alba: 1th to 6 weeks: White/yellow; creamy,

Histrionic personality disrder

Self-dramatizing, exaggerated or shallow emotional expression Attention-seeking, needs to be the center of attention Overly friendly and seductive, attempts to keep others engaged Demands immediate gratification and has little tolerance for frustration

Surgery what drainage to expect afterwards

Serosanguineous (pink) drainage would be expected 2 hours after surgery, but a dressing saturated with sanguineous (bright red) drainage indicates excessive blood loss with possible hemorrhage; it should be reported immediately to the health care provider for evaluation

Genital herpes

Sexually transmitted No cure

Skin traction watch for

Signs of skin breakdown

Stages of labor

Stage 1 Latent - 0-5 cm cervical dilation Active - 6-10 cm cervical dilation Stage 2 - 10 cm(complete) cervical dilation to birth Stage 3 - Birth of baby to expulsion of placenta Stage 4 - 1-4 hours after birth, maternal physiologic readjustment

Middle East respiratory syndrome (MERS) protection?

Standard, contact, and airborne precautions with eye protection when caring for clients with MERS.

Medication and blistersed lesions on the face and trunk

Stevens Johnson Syndrome

If the chest tube is disconnected

Submerge the distal end of the chest tube 1-2 in (2-4 cm) below the surface of a 250 mL bottle of sterile water or saline.

Suction

Suction should be set at medium pressure (100-120 mm Hg for adults, 50-75 mm Hg for children)

Retinal detachment type of vision loss? s/s?

Sudden onset of light flashes, floaters, cloudy vision, or a curtain appearing in the vision.

Buck traction

Supine or in semi-Fowler position (max 20-30 degrees)

Aortic stenosis s/s

Systolic ejection murmur

Examples of airborne diseases

TB, Varicella zoster (chickenpox), Herpes zoster (shingles), Rubeola(measles),

Levothyroxine

Take on empty stomach

Postpartum fever

Temperatures up to 100.4°F (38°C) in the first 24 hours after birth often are related to the dehydrating effects of labor. The appropriate action is to increase hydration by encouraging oral fluids

An elevated carbon dioxide (CO2) level (normal: 35-45 mm Hg [4.7-6.0 kPa]) is usually an indicator of hypercapneic respiratory failure

The bilevel positive airway pressure (BIPAP) machine will provide positive pressure oxygen and expel CO2 from the lungs

Sublingual nitroglycerin Teaching?

The client should be instructed to take 1 pill (or 1 spray) every 5 minutes for up to 3 doses, but emergency medical services (EMS) should be called if pain is unimproved or worsening 5 minutes after the first table

COPD

The client with chronic obstructive pulmonary disease and peripheral edema may have cor pulmonale, or right-sided heart failure, from vasoconstriction of the pulmonary vessels. Cor pulmonale is treated with long-term, low-flow oxygen; bronchodilators; and diuretics. This client should be seen second. Right-sided heart failure (peripheral edema) is not as dangerous as left-sided heart failure (pulmonary edema).

ductus venosus

The ductus venosus connects the umbilical vein to the inferior vena cava

Plantar creases on an infant

The more they have the more mature the are

Collect non sterile urine specimen from a child who is not toilet trained

The nurse can place several cotton balls in a dry diaper and later squeeze urine onto a dipstick

Delirium

The signs are acute mental status changes that fluctuate and inattention with disorganized thinking and/or altered level of consciousness. The disorganized thinking includes hallucinations

Sublingual nitroglycerin

They should be stored away from light and heat sources, including body heat, to protect from degradation. Clients should be instructed to keep the tablets in the original container. Once opened, the tablets lose potency and should be replaced every 6 months. The car is not a good place to store NTG due to heat

Diagnosis of "anxiety"

Too broad

Dexamethasone for?

Treat cerebral edema associated with a brain injury/tumor by decreasing inflammation.

Varicella-zoster infection

Treatment is supportive: - Cool oatmeal baths and topical antihistamines (eg, diphenhydramine) applied to lesions for itching - Acetaminophen as needed for fever or pain - Immunocompromised clients (eg, clients with acute myelogenous leukemia [AML]) are at risk for severe varicella (eg, disseminated, pneumonia) and require aggressive therapy, including an antiviral agent (eg, acyclovir). Antiviral therapy should be continued until all the lesions have crusted over. Also don't give the vaccine since they are immunosupressed

Car seats

Tucking blankets between the newborn and the harness or dressing the newborn in bulky coats or a sleep sack reduces the car seat's effectiveness - 0-2 (rear-facing) - 2-7 (forward facing) - 4-12 (booster seats) - 8+ (seat belt) - When the car seat tilts back at a 45-degree angle, there is less danger of the newborn's head and neck falling forward and obstructing the newborn's airway.

Infliximab, adalimumab, and etanercept

Tumor necrosis factor(TNF) inhibitors - Suppress the inflammatory response in autoimmune diseases such as rheumatoid arthritis, Crohn disease, and psoriasis - Immunosuppressive action of TNF inhibitors, clients taking these drugs are at increased risk for infection - Clients should have a baseline TST before initiating therapy and yearly skin tests thereafter. Those with latent tuberculosis (TB) must be treated with antitubercular agents before initiating treatment with these drugs. Otherwise, TB reactivation would occur

Administration from a glass ampule

Use a filter needle

Pediculosis pubis

Use lice treatment shampoo

Anaphylaxis

Vasodialtation Tachycardia Upper airway edema Bronchospasm Urticarial rashm pruritus, flushing Nausea, vomiting, abdominal pain

Injection site for infants?

Vastus Lateralis (Anterolateral thigh)

Hypomagnesemia

Ventricular arrhythmias (torsades de pointes): This is the most serious concern (priority). Neuromuscular excitability: Manifestations of low magnesium, similar to those found in hypocalcemia and demonstrated by neuromuscular excitability, include tremors, hyperactive reflexes, positive Trousseau and Chvostek signs, and seizures.

Venturi mask, non-rebreathing mask

Venturi - is a high-flow device that delivers a guaranteed oxygen concentration regardless of the client's respiratory rate, depth, or tidal volume (TV) - usually used short term. It is often used for clients with low saturations resulting from asthma, pneumonia, trauma, and severe sepsis; it is not the most appropriate device for a COPD client in this situation.

Leukopenia

WBC < 4000

Plugging a tracheostomy tube

When plugging a cuffed tracheostomy tube, the cuff must be deflated. If it remains inflated, ventilation cannot occur, and respiratory arrest could result.

Increased ICP

When the fontanels have closed, nausea, excessive vomiting, diplopia, and headaches become pronounced, with headaches becoming more prevalent in older children.

HIV post exposure prophylaxis

Within 2 hours

gynecoid pelvis

Your type of pelvis is the most favorable for labor and birth

Holter monitor

a portable electrocardiograph that is worn by an ambulatory patient to continuously monitor the heart rates and rhythms over a 24-hour period

Myopia

a vision condition in which people can see close objects clearly, but objects farther away appear fuzzy

Placental abruption

abdominal pain, dark red vaginal bleeding

Lateral Violence

acts of aggression carried out by a co-worker against another co-worker and designed to control, diminish, or devalue a colleague -Documenting and keeping a file of all incidents -Reporting the incidents to the immediate supervisor -Letting the bully know that the behavior will not be tolerated -Observing interactions between the bully and other colleagues (may validate the victim's experiences and serve as a source of support) -Seek support from within the facility or from an external source

Which patient cannot sign out against medical advice?

altered consciousness, mental illness (ie, a danger to self or others), and being under chemical influence

Clonidine

antihypertensive

Levetiracetam for?

antiseizure

Kidney pelvis catheter

are irrigated using gentle pressure and small amounts of sterile saline solution (≤5 mL at one time) to avoid damaging renal tissues.

Assault x Battery

assault = is an act that threatens the client and causes the client to fear harm battery = actual use of force

"Death rattle"

atropine(anticholigernic, it dries the secretions) drops administered sublingually or a transdermal scopolamine patch.

Leukemia

bone marrow aspirate and biopsy, which is considered positive if blast cells are present.

Montelukast

both bronchodilator and anti-inflammatory effects; it is used to prevent asthma attacks but is not recommended as an emergency rescue drug in asthma.

infant pulses

brachial

ICP - Cushing triad s/s is most characteristic

bradycardia, irregular respirations, and hypertension with a widening pulse pressure

Absence seizures

brief loss of consciousness and an appearance of inattention or daydreaming (the absence attack)

Cleft palate How to prevent baby from putting their hand into their mouth

can use elbow restraints on child to prevent hands into mouth

Von Willebrand Disease

causes platelets to adhere to damaged endothelium.

Psychomotor retardation

clinical symptom of major depressive disorder. Manifestations of psychomotor retardation include slowed speech, decreased movement, and impaired cognitive function. The individual may not have the energy or ability to perform activities of daily living or to interact with others. Psychomotor retardation may range from severe (total immobility and speechlessness -catatonia) or mild (slowing of speech and behavior).

Misoprostol

combats uterine atony by contracting the uterine muscle, rather than through vasoconstriction, making it a safe option for clients with hypertension. The drug is often given per rectum for PPH to increase absorption.

Large body cast at risk for?

constipation due to immobility

Respiratory syncytial virus

contact precaution

Bisphosphonates, such as alendronate (Fosamax), risedronate (Actonel), or ibandronate (Boniva)

decrease bone resorption so that loss of bone density is minimized. They must be consumed in the morning, on an empty stomach, with at least 30 minutes before other drugs. The medication is taken with a full glass of water and the client must remain upright for at least 30 minutes to aid absorption and prevent esophageal irritation

Orthostatic hypotension

decreased systolic BP ≥20 mm Hg, decreased diastolic BP ≥10 mm Hg

Antihistamines

diphenhydramine [Benadryl], loratadine [Claritin], promethazine [Phenergan]

Live vaccines examples?

eg, varicella-zoster vaccine, measles-mumps-rubella, rotavirus, yellow fever, influenza nasal spray) - Given at 2-49 years - Inactive - give >6 months

Human chorionic gonadotropin what test it this?

for pregnancy

Open angle glaucoma what kind of vision loss?

gradual loss of peripheral vision - tunnel vision

Esophageal cancer

high intake of nitrosamine-containing foods (eg, pickled foods, beer), frequent ingestion of extremely hot beverages (thermal injury), and deficient intake of fruits and vegetables

Palms of the hand and soles of the feet assessment for African American

ideal locations for assessing other skin color changes that may occur in dark-skinned clients, such as jaundic

Common causes of decreased milk

inadequate rest or diet; smoking by the mother or others in the home; and use of caffeine, alcohol, or other medication

Infective endocarditis risk factorS?

inflammation of endothelium that lines heart and cardiac valves. most commonly damages mitral valve, then aortic and tricuspid valves. commonly caused by bacteria that are normally present in the body. can also occur after an invasive medical or dental procedure. symptoms: valvular dysfunction, may affect organ systems, chest pain, CHF, clubbing, meningitis, low back pain, arthralgia, arthritis - Prophylactic antibiotics prior to dental procedures - Prosthetic heart valve or prosthetic material used to repair heart valve - Previous history of IE - Some forms of congenital heart disease (Unrepaired cyanotic congenital defect Repaired congenital defect with prosthetic material or device for 6 months after procedure Repaired congenital defect with residual defects at the site or adjacent to the site of a prosthetic patch or device) - Cardiac transplantation recipients who develop heart valve disease

Codeine

is a narcotic analgesic used for acute pain or as a cough suppressant. Depressing the cough reflex can cause an accumulation of secretions in the presence of chronic obstructive pulmonary disease (COPD), leading to respiratory difficulty.

Seizure

is a sudden, uncontrolled electrical disturbance in the brain. It can cause changes in your behavior, movements or feelings, and in levels of consciousness. If you have two or more seizures or a tendency to have recurrent seizures, you have epilepsy.

Foramen ovale

is a temporary opening between the right and left atria

.Microcephaly

is an effect of fetal alcohol syndrome or cytomegalovirus infection.

Coronary arteriogram

is an invasive diagnostic study of the coronary arteries, heart chambers, and function of the heart. It requires that the client have an intravenous (IV) line started for sedating medications; the femoral or radial artery will be accessed during the procedure. Not to eat or drink anything for 6-12 hours prior to the procedure (depending on the particular health care provider performing the procedure) (Option 4) The client may feel warm or flushed while the contrast dye is being injected (Option 2) Hemostasis must be obtained in the artery that was cannulated for the procedure. Most commonly, this is the femoral artery. Compression is applied to the puncture site and the client may have to lie flat for several hours to ensure hemostasis (Option 1)

Meconium ileus

is classic for cystic fibrosis, a genetic disorder

Dystocia

is difficult labor that is prolonged or more painful than expected

External pacing

is indicated in symptomatic bradycardic (<60/min) rhythms

Postherpic neuralgia

is the most common complication of shingles. The condition affects nerve fibers and skin, causing burning pain that lasts long after the rash and blisters of shingles disappear. ... For most people, postherpetic neuralgia improves over tim

Floppy muscle tone

is typical for Down's syndrome, a genetic disorder.

Dysarthia

is weakness of the muscles used for speech. Pronunciation and articulation are affected. Comprehension and the meaning of words are intact, but speech is difficult to understand (eg, mumble, lisp).

TB during pregnancy

isoniazid plus rifampin daily for 9 months. Ethambutol is added initially if medication resistance is suspected. Pyridoxine (vitamin B6) often is administered with isoniazid to prevent fetal neurotoxicity

If possible spine injury

jaw thrust technique to open airway

ductus arteriosus

joins the aorta and the pulmonary artery.

Pundendal nerve block

least maternal/newborn side effects and could be administered quickly by the health care provider. It does not relieve contraction pain but does relieve perineal pressure when administered in the late second stage of labor

New ileostomy diet?

low fiber diet

Neonatal heel stick

manifests with pleural friction rub, a loud, rough rubbing or grating sound heard throughout inspiration and expiration that is caused by the pleural surfaces rubbing together. Pleural friction rub sounds similar to crackles, but crackles are typically heard only during inspiration

Vaginal discharge at the end of pregnancy

may become mucoid and blood-tinged (pink/brownish) in the days preceding labor.

Anticholigernic

medications (eg, benztropine, trihexyphenidyl) are commonly used to treat tremor in these clients. However, in clients with benign prostatic hyperplasia or glaucoma, caution must be taken as anticholinergic drugs can precipitate urinary retention and an acute glaucoma episode

Physical therapy

mobility, ambulation, ability to transfer, and use of related equipment.

TB indication of being resolve

must have sputum cultures performed every 2 to 4 weeks after initiation of antituberculosis medication therapy. The client may return to work when the results of three sputum cultures are negative because the client is considered noninfectious at that point

Risk factor for breast cancer

nulliparity or first child born after age 30 years; early menarche; late menopause; family history of breast cancer; high-dose radiation exposure to the chest; and previous cancer of the breast, uterus, or ovaries.

Regular insulin

onset of action is 60 to 120 minutes, it peaks in 6 to 14 hours, and the duration of action is 16 to 24 hours.

IV Hydromorphone

over 2-3 min

6p

pain, pressure , paresthesia, pallor, pulselessness, paralysis

Examples of Droplet precautions

pertussis, influenza, meningitis, mumps, rubella, strep throat, diphtheria(A serious infection of the nose and throat that's easily preventable by a vaccine. A sheet of thick, gray matter covers the back of the throat, making breathing hard)

Petechiae for Africa American

petechiae can best be assessed in the conjunctivae of the eyes and the buccal mucosae.

Narcotics common side effect?

pruritus, constipation, nausea or vomiting

Apraxia

refers to loss of the ability to perform a learned movement (eg, whistling, clapping, dressing) due to neurological impairment.

Tinea corporis

ringworm

Tinea corporis

ringworm - fungal infection of the skin often transmitted from one person to another or from an infected animal to a human spread via items

Hydrocele

scrotal swelling caused by a collection of fluid

Nasopharangeal airway

should never be inserted in clients who may have head trauma

Open bottle of sterile saline

some facilities allow reuse within 24 hours

West nile virus - spread?

spread to humans by the bite of an infected mosquito

Phenytoin x tube feeding?

stop the feeding for 1 to 2 hours before and after administering phenytoin as products containing calcium (eg, antacids, calcium supplements) and/or nutritional enteral tube feedings can decrease the absorption and the serum level of this drug

The amniotic fluid

surrounds, cushions, and protects the fetus and maintains the body temperature of the fetus. -

Narrow pulse pressure

the difference between systolic and diastolic) is a sign of hypovolemic shock and would not indicate adequate rehydration.

Dagibatran

thrombin inhibitor

Circumcision

yellow exudate is normal, bleeding smaller than a quarter is normal